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There is a steady reduction in each successive decennium
in the number of diphtheria deaths, and in the last two decennia
in the case mortality. This is no doubt accounted for, to some
extent, at least, by the measures taken for the control of
diphtheria—quick detection of the disease by the doctor called
in, rapid removal to hospital, efficient treatment, especially in
relation to adequacy of dosage of antitoxin, together with
measures to prevent the spread of infection at home.
It is well, however, to remember that the change in age
constitution of the population during the forty years under
review would naturally tend to favour a fall in the incidence of
diphtheria. The census population of 1901 was 72,056, that
of 1931 was 95,523, and, if a census had been possible in normal
conditions in 1941, the total population of the Borough would
almost certainly have been over 100,000. But whereas 26 per
cent, of the 1901 population was under 15 years of age, only
17 per cent, of the 1931 population was under 15, and if a census
had been taken in 1941, the proportion under 15 would probably
have been in the region of 14 per cent. The full in the birth
rate has cost us nearly half our child population in forty years.
The diphtheria-susceptible elements in the population are being
separated—and so to some extent protected from infection—by
the older immune elements in the population.
The question might be asked whether 27 deaths in ten
years—an average of less than three per annum—is not in itself
a satisfactory achievement compared with the early years of the
century. The answer is that, since the perfecting of the process
of artificial immunisation in the last few years, its complete
safety and reliability—27 deaths from diphtheria in ten years
are just 27 too many. Our aim should be a decade without a