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Secondary infection occurred in two households, in each case the
infecting patient being a London child and the case proving fatal.
There was one return case, that of a girl of three in a household
where there had been two cases, the onset of illness in the case being
some six days after the return home of the infecting case.
Five were bacterial cases only, three of these giving positive nasal
swabs.
The age distribution of the cases is of interest. Of those proved
to be diphtheria 25 per cent, were under five years of age, 35 were of
school age, and 40 per cent, were over fifteen.
Place of Treatment.
All but three of the patients were admitted to the Harrow Isolation
Hospital, these three being removed from general hospitals outside the
district.
Deaths.
Three of the patients notified as suffering from diphtheria succumbed
to the infection ; in one case, however, death occurred on the first day
of the following year. The other two cases were of children ordinarily
resident in London and whose deaths are therefore not included in the
mortality returns for this district. The first of these fatal cases was a
boy of five who was admitted on the fourth day's illness of laryngeal
diphtheria. The second was a boy who, on the fourth day of illness was
taken to a general hospital from which he was removed to an isolation
hospital not in this district. The third fatal case was that of a girl of
17 who was admitted on the eighth day of illness.
Immunization.
Although the number of children immunized against diphtheria in
the later months of 1940 had been rising, the effects of the national
publicity campaign are shown markedly by the number of cards received
in the different months. It should be appreciated that any case is
recorded in the month the card is received, that there is not less than
one month's interval between the two doses, and that frequently there
is a lapse between the date of the final dose and the date the card is
sent in. Early in the year arrangements were made for treating the
children attending the infant welfare centres, while the county school
medical staff kindly undertook the work at the schools and school clinics.
Cards from these two sources were received first in March. Those from
the infant welfare centres have been maintained up to the end of the
year at a fairly even rate of some 100 per month, the total number of
children treated being 1,184. The arrangements at the schools proved
quite popular in the summer months but very little was done in the
Christmas term. Altogether, 1,094 were treated at the schools or school
clinics.
March showed a sharp rise in the monthly rate of 150 to over 400
in the cards received from general practitioners. The figure rose through
the summer to 600, falling in September to 500 and then declining each
month to a figure of about 250 in December. The total number of