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DIPHTHERIA.
There were 52 cases of Diphtheria notified during 1935, as compared
with 24 in 1934, and an average of 18 cases per annum since the formation
of the Urban District, with the exception of the period 1920-24, when
the average was 60.
The increased incidence was almost entirely confined to one Ward,
where 73 per cent, of the cases occurred. The history of this epidemic
is an interesting one : first, in the limitation of the outbreak to this
locality, which is not otherwise isolated from the remainder of the Urban
District; second, in the comparatively small number of cases which
occurred compared with the large number exposed to the risk of infection,
especially when it is realised that no epidemic has occurred in this district
during the last 11 years. Further, this is not a highly urbanised population
such as is usually associated with a good percentage of normally
immunised individuals.
The outbreak in this part of the District began in June, and at an
early stage affected 4 out of 5 children of one family who were admitted
to Hospital with positive swabs in that month. Six further contacts
were admitted before the end of July, when a break in the epidemic
occurred lasting until September. Meanwhile, after giving a series of
negative swabs, the family referred to had returned from Hospital and
continued to give negative swabs off and on until the end of October.
By that time 13 more children from the schools or locality frequented
by the returned children had been admitted to Hospital. Two of the
original children were then found to be still harbouring Diphtheria
bacilli, and, together with the fifth child who had previously avoided
detection, returned to Hospital, to be joined a fortnight later by a further
member of the family, who had been negative in September and October.
Six more direct or indirect contacts with these children were admitted
in November and December, one of whom unfortunately died. The
epidemic appears to have died out gradually in the early months of
1936.
It is, of course, not assumed that all the carriers were detected, as
general swabbing was not resorted to in the schools. On the contrary,
it is highly probable that a number of other children acted as temporary
carriers. What is remarkable is that with a presumably unimmunised
population, which mixes freely in and out of school, more clinical cases
did not occur. The value of the removal of definite carriers is once
more confirmed, but the difficulty associated with the detection of intermittent
carriers is also well illustrated. (While several members of the
unfortunate family presented sore noses or nasal discharge from time
to time, which eventually cleared up with treatment, no member was
ever ill from the disease). It is interesting to surmise what would have
been the cffect on the outbreak had a section of the population been
immunised.
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