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7
DIPHTHERIA.
After three years, during which very few cases of
diphtheria occurred in the District, a slight increase was
experienced in 1940 when 25 cases were notified. Nearly half
the cases, however, occurred in, January, following an outbreak
in Coulsdon around Christmas, 1939. In this outbreak the
majority of cases occurred among adults. By March it had died
out. In July a further case was notified but proved to be
tonsilitis only, while in August two isolated cases occurred in
children in Sanderstead and Selsdon. No further cases occurred
in the District as a whole during the remainder of the year, but
six cases of diphtheria were diagnosed among a series of cases
of scarlet fever among the children of Reedham Orphanage between
September and November. Further reference to these cases will
be found in the section on scarlet fever. Fortunately, no
deaths from diphtheria occurred during the year. It is hoped
that with the greatly increased proportion of children who have
been immunised against this disease since the end of the year
that the number of cases occurring in future years will be
greatly reduced. Only 140 children received or completed the
full course of treatment for their immunisation against
diphtheria at the two clinics established by the Council during
1940.
TYPHOID FEVER.
Eight cases of typhoid fever were notified during the
year but all except one occurred in one of the mental hospitals
in the District. The source of infection in the isolated-case
could not be traced. The Institutional cases were caused by
chronic carriers, inspite of the general use of T.A.B. vaccine;
thus one case had only received injections 9 months previously.
PARATYPHOID FEVER.
Of the 45 cases of paratyphoid fever notified during
1940 only one was in the District as a whole, and again the
source of infection could not be traced. Forty-three of the
cases occurred in one of the mental hospitals in the month of
June and were due to B. Paratyphosus B. All except one of the
cases occurred in one of the blocks of buildings and was thought
to have been associated with certain food but unfortunately, as
so often happens, the first notification was not received until
some time after the suspected food had been eaten or destroyed.
Of the 43 cases notified 22 were as a result of
bacteriological examination of the faeces only, the cases
presenting no symptoms. One member of the staff only was
affected. Four of the inmates affected died as a result of
the disease.
By the usual measures for Immunisation, isolation,
disinfection, etc., the outbreak was limited, once it was
recognised, to one block of buildings.
SCARLET FEVER.
The number of cases of Scarlet Fever notified during
1940 was about the average for the preceding 4 years, viz. 6l.
This number would have been still smaller but for an outbreak at
Reedham Orphanage between September and November in which 20
children contracted the disease. The outbreak at this
institution is of interest in several respects. The first
case, which was taken ill on the 12th September, was one of
32 infants who were sleeping every night in the Air Raid
shelter in close proximity with each other and with approximately
79 girls. It was found that a number of the other infants
had colds and sore throats at this time and owing to the very
frequent raids it was impossible to segregate the children with
these possibly premonitary symptoms or to determine by swabbing