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Where more than one case occurred in a household, consideration of the dates of onset of the second or
subsequent cases showed that, in the majority, infection had occurred prior to the diagnosis of the first
case. In other words, if the case can be isolated at home there is no advantage to the community
in removing it to hospital. All persons suffering from tonsilitis should be considered infectious and
should remain in isolation at home until the attack has subsided.
An interesting sidelight on the age distribution of our population is revealed by the above investigation,
which shows that of home contacts children are only half as numerous as adults.
DIPHTHERIA.—The lowest incidence of this disease recorded in the Borough occurred in 1943,
which is also the only year in which no death from diphtheria has been recorded. During the eight
years under review there were 18 deaths from diphtheria: five in 1939 and 1940, three in 1941, two in
1945 and one in 1942, 1944 and 1946. Of the 228 cases and 18 deaths during 1939-46, twelve and
one respectively had been immunised.

The proportion of the child population immunised is too small if the disease is to be kept under control.
Since the start of the scheme in 1930 careful records have been kept, and thus the progress of our
immunisation scheme can be studied in relation to diphtheria notifications and deaths. In recent years
special efforts have been made to secure the immunisation of young children, but to date the proportion
immunised before reaching school age falls far short of what is desirable. " There is still room, therefore,
for further effort to reduce the incidence of diphtheria, to mitigate its severity, and perhaps even
to remove it from the lists of causes of death."
ERYSIPELAS.—This disease, a streptococcal infection, has been less prevalent in recent years;
average number of cases per annum was 51 in 1930-34 as compared with 18 in 1942-46. The three
fatal cases during 1939-46 were over 65 years of age.
PNEUMONIA.—The notifications of pneumonia in recent years have been small; annual average
of 181 in 1930-34 as compared with 62 in 1942-46. There is reason to believe that this is due more to
failure on the part of medical practitioners to notify all cases rather than an actual reduction
in incidence. The average death rate per 1,000 population from pneumonia was 0.6 in 1930-34 and
CEREBRO-SPINAL FEVER.—An outbreak of cerebro-spinal fever occurred in 1940-41 and the
disease (13 cases in 1946) has not yet returned to its pre-war level. By the use of sulphonamide drugs
the mortality from this disease has been greatly reduced.
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