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37
DIPHTHERIA.
Incidence.
Eighty-seven notifications were received during the year,
though in a number the diagnosis was subsequently amended.
Seventy-eight cases in a population of 188,710 gives a rate per
thousand of 0.41 a rate which although a slight rise on that for
last year is only in conformity with the rates experienced by the
district of recent years. (For the years 1934 to 1939 the figures
were:—0.60, 0.58, 0.22, 0.54, 0.34, 0.28.)
The incidence throughout the year was fairly even, the number
of cases notified each quarter being 13, 21, 19 and 28. The number
for the last quarter was swollen because of the occurrence of 9 cases
in one family.
An unusual proportion of households were affected by
secondary infection: (1) A girl of 2 who fell ill on May 29th was
removed to hospital on June 1st, on which day her sister, aged 6,
fell ill. (2) A girl of 8 fell ill on April 28th, and her sister on May
1st, both being removed to hospital on May 3rd. Some weeks later
two members of the same family were admitted to hospital, both
suffering from aural diphtheria, but neither giving a history of
any affection of the throat. (3) A girl of 16 whose illness dated
from October 9th, but who was not removed to hospital until the
14th, apparently infected her brother whose onset was the 10th,
and another girl of 3 in the house who fell ill on the 14th. (4) On
the same day five members of the same family whose illness was
alleged to have started only on the day before were admitted to
hospital. One, a girl of 10 who suffered from rhinorrhoea had
nothing on her throat and gave no history beyond that of a cold.
Her subsequent progress, however, only confirmed the suspicion
that she had been a missed case, and was probably the source of
origin of the illness in the others. Within the next two or three
days a further four members of the household were affected.
There were two return cases, being the parents of a boy of
three years of age, who had been admitted to hospital on February
7th, being discharged on May 8th and who developed a nasal
discharge.
Two patients were bacteriological cases only; two suffered
from laryngeal, two from nasal and one from aural diphtheria.
In the course of the year 18 patients were admitted from the
Orthopaedic Hospital. Though many of them came from the same
ward investigations of the ward staff failed to show that anyone
was acting as a carrier. Some of those admitted were only bacteriological
cases. The distribution of the cases in time was most
erratic. Three cases in the week ending February 10th were
separated from four in the fortnight ending June 22nd, by one
case in the week ending April 20th; single cases in the weeks ending
July 27th, September 14th, September 28th and October 5th and
12th were followed by four in the three weeks ending December 28th,