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most pronounced among the susceptible infant school children.
Localisation of infection in and around certain infant
schools was well defined and in this respect the West Central
Ward was particularly affected. The monthly .incidence of
cases was as follows.
Jan. Feb, Mlarch April May June July Aug. Sep. Oct. Nov. Dec,
26 30 41 22 28 23 J 46 42 48 67 35 28
These figures show the continued high incidence during
the year and the chary characteristic rise in the Autumn. At the
end of the year there was evidence of less localisation of
infection and a tendency towards decline.,
All the factore involved were considered in consultations
with the school medical officer and efforts were made to
reduce infection in schools by extending the period of
exclusion of suspected carriers, by adjusting educational
methods likely to favour the spread of infection, by the
maximum use of floor space and fresh air, and concurrently
by close attention to individual cases and their contacts.
During the period of maximum incidence the hospital
accommodation for eases of scarlet Fever was severely taxed,
and every effort was made to arrange for the treatment of
cases at home, where conditions for homo nursing were
suitable.
DIPHTHERIA Seven cases were notified during 1943,
a reduction of nineteen cases on the number for the previous
year. Four of the cases were from institutions. There
was one death of an adult from laryngeal infection. Of the
three cases occurring in the district two were adults.
One was a child of fourteen years who had been immunised, and
who suffered primarily from septic tonsilitis, but carried
diphtheria bacilli in the throat. The case rate was 0.09
per 1000 of population compared with 0.88 per 1000 of
population for England and Wales.

x Immunisation commenced.
The above table is of interest in showing a general tendency
towards decline in the number of notified cases. There is
also evidence of reduction of mortality. During the nine
years since the introduction of the scheme no immunised child
has died of Diphtheria in this Borough. During the same
period four immunised children have been notified as cases
of Diphtheria and all suffered from mild attacks. The
trend towards decline of the incidence and mortality of
Diphtheria justifies a belief that the beneficial influence
of diphtheria immunisation is in operation.
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