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78
"...it would seem that there are, scattered throughout the
different age groups, a considerable number of children who have
never had measles, and over the years the proportion of susceptibles
accumulates. Sooner or later the year arrives when each successive
separate focus of measles is no longer surrounded by a closing ring
of immunes but only by yet more susceptibles. In such circumstances,
an exceptionally large epidemic might be expected."
"...Outbreaks of measles do not end from the exhaustion of
the supply of all further susceptibles but from lack of susceptibles
in the immediate circle of individual sufferers. When the outbreak
has run its course and a sufficient number of foci (cases) has become
'ringed off® by immunes, the outbreak ends, usually quite suddenly."
"Where the age groups on which the threatened outbreak
presses most heavily already contains 30 per cent. or more children
who have previously had measles, the ring of immunes round each case
is already partly present and rapidly becomes complete, this being
the position in 'non-epidemic' years."
"Where the percentage reaches 70 in 5and 6-year olds and is
proportionately high in the adjoining groups, measles may fail to
get any real foothold at all, and there is no 'outbreak'."
"As long as the percentage remains below 45 in the 5 8s
there is always the chance that circumstances may favour widespread
linking of infection, finding the 'gaps' in the very incomplete
circle of immunes round each case instead of meeting a reasonably
solid wall of immunity. This would explain the occasional 'epiphenomenal' epidemic of measles."
This would appear to be the case in Kensington in the year
of writing, when the total number of notifications in the current
epidemic has already reached 1,632, exceeding the highest epidemic
number since notifications began by nearly 400. In my Annual Report
for 1950 I reproduced a graph showing the incidence in four-weekly
periods during the preceding ten years. This graph has now been
continued to 1960, and it will be seen that the number of cases
notified, regularly continues to rise to a maximum at intervals of
two years.
Ophthalmia Neonatorum
Six cases were notified to me during 1960. Pour of these
occurred at the patients' homes. The other two were cases occurring
in Kensington hospitals and were infants whose parents were not
normally resident in the borough. All the patients fully recovered
with no impairment to vision.
Gastro-enteritis
This disease is notifiable in children up to the age of
five years. The number of cases reported during the year was 9.
Six were removed to hospital for treatment. One death of a child
under five years of age (not a notified case) was recorded as due
to "gastritis, enteritis or diarrhoea" in 1960.
Scabies
The number of scabies notified during 1960 was 28, which
compares with 463 notified in the peak year of 1946.
Tuberculosis
During the year 164 new cases of tuberculosis were notified,
of which 147 were respiratory and 17 non-respiratory.