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43
Diphtheria.
There were only eighty cases of diphtheria notified during the
year, being a rate per thousand population of 0.60 compared with
the figure of 1.70 for the country as a whole. The weekly incidence
throughout the year was low, rising somewhat in the last three
months of the year. For the previous five years a similar low
incidence has prevailed throughout the constituent districts.
In view of this low incidence, coupled with the rapid importation
of a population probably of abnormal age distribution, with a
relative excess of child population, the herd immunity of the
district to diphtheria must be low.
Most cases were removed to the Rayners Lane Isolation
Hospital, though a number, owing to absence of accommodation
locally, had to be admitted to the hospitals of other authorities.
A large number of the cases were secondary infections. Two
missed cases each gave rise to two cases, one case gave rise to four
secondary cases, and six cases gave rise to one each. Apart from
these, a nasal case gave rise to four, making a total of eighteen
secondary infections arising from ten primary cases.
Two return cases followed on the discharge home of a patient
admitted to hospital for diphtheria, and one of a patient sent in
with scarlet fever.
There were four cases of double infection, the other disease
in three instances being scarlet fever, and in the remaining one,
chicken pox.
One case followed a few days after the removal of adenoids,
and another, which proved fatal, after removal of tonsils and
adenoids. One case of epidermal diphtheria was notified, the
lesion occurring on the skin starting at the edge of a lung sinus.
Eight deaths, seven male and one female, were certified as
being due to diphtheria, being a case mortality of 10 per cent.
In one, however, the patient, suffering from nasal diphtheria,
developed appendicitis and peritonitis, which proved fatal. In
another, a female of 69, the death certificate dated November 8th,
read 1 (a) bronchitis, (b) pericarditis, (c) diphtheria, the onset of
the attack of diphtheria being June 4th.
Bacteriological Examinations.
987 diphtheria swabs were examined during the year at the
Laboratories of the Clinical Research Association.
Schools and Diphtheria.
Schools appeared to play a very small part in the spread of
the infection. In one department, three cases were notified in
the same week, two of the affected children being in the same class.
Apart from this instance, there was no association between the
incidence of diphtheria and school attendance. No schools were
closed during the year on account of diphtheria, and no school or
school rooms fumigated.