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42
DIPHTHERIA.
Incidence.
Thirty-eight notifications were received during the year. In 21
instances the patient was suffering from some other condition, most
frequently tonsillitis. The corrected figure of 17 is a rate of 0.08 per
thousand population, compared with the national rate of 0.28. The
local rates for the years 1934-1945 ranged from 008 to 060.
A substantial proportion of the population has been immunised
against diphtheria, and the very low incidence of this infection could
be attributed to these endeavours. On the other hand, though the district
had had a similar freedom even before many of the children had been
treated. The steady fall in the incidence of diphtheria throughout the
country, a fall which has coincided with the successful national efforts
to see that most children are treated, must be held to be related to this
treatment.
Of the 13 cases, 2 were under five years of age, both being infants
suffering from laryngeal diphtheria, 6 were between 5 and 15, while the
others were over 15, all but one being adults. Five children were members
of one family, all being ill together. Of these, two had been inoculated
in 1942 with 0.2 and 0.5 c.c. A.P.T., but neither was subsequently Schick
tested.
Places of Treatment.
All notified patients were admitted to the isolation hospital for
treatment, 12 cases up to the end of February to the Harrow Isolation
Hospital, the remainder to the hospitals of other authorities.
Deaths.
None of the cases notified locally proved fatal. There was a
transferred death in which diphtheria was the cause. This child of
six, a pupil at a boarding school, who had not been immunised, succumbed
to what is reported to have been a very toxic fulminating attack.
Immunisation.
The same facilities were available for the immunising of children
against diphtheria. The numbers of children treated had fallen from
7,366 in 1942 to 2,359 in 1944. In 1945, 3,111 were treated and last
year, 2,889. When the scheme was first introduced the only arrangement
was for the inoculation by the general medical practitioners. With the
introduction of the national campaign in 1941, arrangements were made
for the treatment at the clinics of those children who were regularly
brought to the clinics. Since 1943, slightly more are treated in this
way now than by the local doctors—this last year very many more.
This is due less to an increase in the number of those done at the clinics
(1,885 cases in 1946, as compared with 1,934 in 1945) than to a falling-off
in the numbers treated by the doctors (the 1946 figure of 928 as against
1,023 in the previous year). Seventy-six were treated at the nurseries.
Concentrating on those attending the clinics undoubtedly involves the
least expenditure of time. They are brought very frequently and are in
contact with others, most of whom have been treated.