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2.75. The corresponding rates for the country as a whole were
1.18 and 4.54, giving a proportionate local incidence in the two
groups of 0.96 and 0.60.
There were no return cases, but 10 cases of secondary infection.
Two of these were secondary to a missed nasal case ; in another
the onset was before the removal to hospital of the primary case ;
and in the case of a further three the onset of the secondary was
within 24 hours of the removal of the primary infecting case. The
remaining case was one whose alleged onset was on the 4th day
after the removal to hospital of the primary patient.
There was no difficulty about removal of patients to hospital
until the latter part of the year, when there was delay in one case.
Six cases were of purely laryngeal involvement.
Localised Outbreak.
The following is a copy of a report submitted on the occurrence
of a localised outbreak:—
In the week ending December 9th, 13 cases of diphtheria
were notified. Apart from this week, throughout the year the
weekly incidence of diphtheria has been low, the only times when
more than four cases have been notified being the weeks ending
September 16th and 30th, when there were five and six cases.
The numbers in the subsequent weeks of the year were two, two.
and one. Of these 13 eases in this week, 8 died. 5 (of which one
was fatal) were scattered in various parts of the district. The
remaining 8 were localised in their distribution, and another case
was notified from the same district in the following week. Of
these 9, 2 were children not attending school. The remaining 7
attended the same school but not all the same department. The
school is a large one with three separate and entirely unassociated
departments. Four attended the infants' department but
apparently only two were members of the same class. Three
the fatal cases were members of one family (incidentally, the
two remaining children of this family were found, on testing,
to be Schick negative). There was, apparently, no association
of the children in other places such as Sunday schools.
The factor of greatest importance in the fatality of diphtheria
is the time which elapses before the patient is under treatment.