THE GRADUAL loss of immunity to diphtheria in the United States among adults has been progressing, while the morbidity has been falling off. This has been going on since about 1915, when diphtheria prophylaxis in the United States was started. The effect was demonstrated when the American military forces went to Europe, where they were exposed perhaps to many more carriers, cases and different strains than in the United States.
This report deals with 216 patients who entered the 59th Evacuation Hospital in Palermo, Sicily, between August 1943 and May 1944. One hundred and thirty-five have been labeled as carriers, and 81 as having toxic diphtheria, though, as will be explained later, some of the former probably also were suffering from diphtheria.
The 413 personnel of the 59th Evacuation Hospital were from all parts of the United States. They served as a partial control for previous susceptibility to diphtheria and