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fact that many cases of comparatively mild disease without any of the classical
signs and symptoms are due to the same infection as bacillary dysentery. Any
enteritis or diarrhoea, however slight, which is found to be due to Shigella is now
reported by that same dread term "dysentery" which used to designate "one of
the four great epidemic diseases of the world" (Osier). "The scourge of armies"
has become the bane of residential nuseries. By gradual steps in 20 years the term
dysentery has been expanded, and now includes not only the fatal cases and those cases
severe enough to be notified on clinical grounds (usually the presence of blood in
the stools and tenesmus) but also all those cases of diarrhoea in which Shigella has
been bacteriologically identified, cases often so mild, except in infants and young
children, that only 1 per cent, of those notified died."
There is no doubt that the extension and improvement of laboratory services
has led to earlier examination of stools, i.e., in the acute stage of disease, so that the
organism is more often identified and every year more cases of milder enteritis are
notified as dysentery. In the circumstances it is necessary to fall back upon the
death certificates for a guide to the trend of incidence. In London, the death-rates
from dysentery since the beginning of the century have been as follows:—
Mean annual rate per 1,000
1901-1910 0.0052
1911-1920 0.0321
1921-1930 0.0054
1931-1940 0.0036
1941-1945 0.0096
1946 0.0035
It would appear that apart from increased incidence during the two wars, the
real incidence of dysentery has remained fairly stationary.
Diphtheria
A satisfactory antigen tor aipntneria propnyiaxis naa Deen iouna long oeiore
the war, and had encouraged the long term view that diphtheria would be stamped
out. When war came the need for preventing epidemic outbreaks of this
damaging disease became even more insistent. A national campaign for immunisation
of children was launched by the Ministry of Health at the end of 1940. Staffing
difficulties and the emergency movement of children during the war made abortive
any attempt to record precisely the proportion of children immunised at any point
of time during the campaign, which is still proceeding, but from various sample
surveys and such other records as are available, the following estimates have been
made and are thought to be correct within a small margin:-
Mid-year Percentage of London children
0-14 immunised
1938 Less than 5
1941 24
1942 37
1943 53
1944 64
1945 70
1946 74
Before assessing the result of the campaign, attention must be drawn to the
apparent cyclical nature of diphtheria epidemics. While there is no sharply defined
periodicity, the following notification rates in London administrative county illustrate
the rise and fall in incidence since 1891
Years Notifications per 1,000 living
1891-95 2.4
1896-1900 2.9
1901-05 1.9
1906-10 1.6
1911-15 1.8
1916-20 2.3
1921-25 2.9
1926-30 2.8
1931-35 2.2
1936-40 1.4