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6 diphtheria.
including 3 of membranous croup). Distributing the cases by Wards, it is found (Table 5) that last
year in Lancaster Gate, East, Ward only was the record in excess of averages for the two preceding
quinquennia. From that Ward 15 cases were notified during the year, as compared with quinquennial
averages of 7 (1913-17) and 13 (1918-22).
Last year's cases comprised 88 in males and 132 in females. The age-distribution is given in
Table 4. The 88 cases in males were 42 per cent. less than the average (153) for 1918-22 and 23 per cent.
less than that (115) for 1913-17. The total of 131 cases in females represents corresponding reductions
of 38 and 10 per cent. respectively. On an assumption of equal susceptibility to the disease, 88 cases
among males would imply 119 among females. If, however, account be taken of the numbers of cases
notified but not subsequently confirmed—"errors," males 18, females 28—the corrected total of 70
cases among males would be equivalent to 95 among females, whereas the actual record was 104.
The age-distribution of cases in males last year shows reductions in all groups except that of 15-25,
which group furnished 9 cases last year as compared with annual averages of 4 during 1913-17 and 10
during 1918-22. Among females the 3 cases reported last year at ages under one year were the same
as the annual averages for the two quinquennia and at ages 15-25 last year's figure of 32 cases was in
excess of the average (18) for 1913-17, and only 1 less than that (33) for 1918-22. In those comparisons
no account has been taken of the "errors," the age distribution of which is peculiar. Of 4 cases
recorded during the year among males aged 0-1 year none were erroneously diagnosed, but of the 3
cases among females of those ages, all. Of the 9 cases among males aged 15-25 there were 4 errors, and
among the 32 in females, 8. The analysis of errors by sex and age has not been made hitherto, so no
comparison with earlier years is possible.
The numbers of cases reported in each quarter of the past year from each Ward are shown in comparison
with the quiniquennial averages in Table 5.
In 107 instances bacteriological examination of swabs from the throat, etc., preceded notification,
positive results being obtained in 100 instances. In 13 patients there were practically no clinical
symptoms, and the patients were considered to be carriers, 11 of them having, however, been removed to
hospital before such decision was made. Apart from those 13 cases there were 40 in which the original
diagnosis was not confirmed by the subsequent course of the disease, such "errors" constituting 20.9
per cent, of the notified cases. During 1918-22 the average percentage of errors was 9.9, the percentage
of errors last year being more than double the average for the preceding quinquennium.
After excluding errors the records show that 2 cases of the disease occurred in each of 11 families
during the year, and 3 cases in each of 2. If the house be taken as the unit and not the family, there
were 2 cases in each of 12 houses, 3 in 2 and 4 in 1.
In 12 instances it has been possible to fix the intervals between the primary and secondary cases.
The intervals between the dates of sickening were : Under 7 days, 3; 7-14 days, 4; 14-21 days, 2; and
21-28 days, 3; and those between the last contact of the secondary case with the primary: Under 7
days, 5; 7-14 days, 1; 14-21 days, 4; and 21-28 days, 2.
In 2 instances two patients were reported on the same day from 2 families. One patient (f.,
set. 25) reported with diphtheria during the past year, had two definite attacks of the disease, the first
in February and the second in May.
In 11 instances the disease was contracted in institutions where the patients were under treatment
for other diseases, in 6 the disease was apparently contracted in out-lying districts, and in 1 it followed
the return from hospital of a previous patient.
Of the 220 notified cases 211 (95.9 per cent.) were removed to hospital, the mean percentage of
removals during 1918-22 being 92.1.
Of the patients whose cases were notified during the year 14 died, including 1 "error," 13 of the
deaths taking place in institutions. After correcting for errors, the total fatality was 7.3 per cent,
last year, or 0.6 above the mean fatality (6.7 per cent.) during 1918-22. The 1 death, which occurred
in the patient's home, represents a fatality of 14.2 per cent, of cases treated in their homes, the average
fatality among such cases during 1918-22 being 7.0 per cent. The fatality among cases receiving
institutional treatment was 7.1 per cent., the quinquennial average being 6.5.
The total number of deaths from diphtheria during the year was 15, the 2 deaths additional to
those mentioned in the preceding paragraph being those of patients whose cases were notified in 1922.
The death rate from this disease was at the rate of 0.09 per 1,000 persons. During 1918-22 the annual
average number of deaths was 22, showing a reduction last year of 36 per cent, of the average.
The 14 deaths comprised 6 of males and 8 of females, giving (approximately) mortality rates (per
1,000) of 0.09 in each case. Those rates were considerably in excess of the means for the years 1910-12
—males 0.05, females 0.07—but below the means for 1920-22—males 0.14, females 0.19.