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44
In ordinary cases, provided treatment is begun early, the case
fatality is low, hut rises with each day of delay that elapses before
specific treatment is started.
There are, however, instances in which from the first the
advantage lies with the organism. Sometimes this seems to be
due to some inherent susceptibility of the patient. It is well
known that it is practically impossible to render some persons
immune to diphtheria, and there are instances of familial susceptibility
which suggest the reason for the ascendance of the
invading organism lies rather in the lack of resistance of the patient
than in the virulence of the organism. In other cases, on the
other hand, the cause of the severity of the attack seems to be
inherent in the organism, some outbreaks containing a heavy
incidence of " bull neck " cases, or of haemorrhagic cases.
The reason for the high fatality of this localised outbreak
seems, in some case, to be due to the delay in obtaining treatment,
but in others to the virulence of the organism. There were 4 cases
probably infected with the same organism, viz.:—3 children of
one family and a school contact. Treatment in these cases was
commenced on the 3rd, 1st., 1st., and 4th days of illness, the
patients dying on the 4th, 5th, 7th and 14th day of illness. One
of the other cases apparently not associated with these, was a
bull neck case for whom treatment was begun on the 4th day of
illness, and a fatal ending occurred on the 5th. In one case treatment
was commenced on the 4th day, death occurring on the 8th,
and in the other no treatment was started until the 10th day,
this case proving fatal on 13th day.
Since diphtheria immunization was started in this district
this is the first instance of a localised outbreak of this nature.
This was reflected in the returns of the consent forms which were
distributed to all the children in the schools, together with a
leaflet outlining the procedure of Schick-testing and immunization.
Ordinarily only about 5 per cent, of consents are obtained from
the forms sent out from the schools; but on this occasion 160
consents have followed the issuing of 900 forms. Included amongst
the children to whom the forms were given there would, of course,
be many who had previously been proved to be Schick-negative.
Death Rate.
There were 11 deaths (2 male and 9 female) recorded during
the year, giving a case mortality rate of 10.2 per cent. Most
these deaths occurred amongst those cases referred to in the
account of the localised outbreak.