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affecting the younger children who, apparently, infected their parents and other
members of the families. With the co-operation of the London County Council, some
alteration in the arrangements and distribution of the communal W.C. accommodation
available was affected. Daily supervision by the Health Visitor and Public Health
Inspector and individual talks with the parents as to the importance of hand
hygiene after using the toilet and before cooking and eating meals, and in view
of the age of the young children involved the supreme importance of cleansing of
door knobs, doors and toilet fittings, as it was found that these children were
having to use adult fitments which occasioned considerable handling of the seat
and pan, this outbreak was very successfully confined and as soon as the precaution
-ary arrangements had been implemented the cases ceased. Some children were kept
under surveillance for up to three months on one case owing to persistent positive
stool, but there were no further cases and eventually all cleared. A particular
difficulty in this establishment is the frequent changing of the families - many
new entrants having come from homes where Shigella sonnei was present. With the
co-operation of the Warden these were all checked on entry and treated immediately
if positive.
This incident did draw attention to a difficulty in the functioning of the
General Practitioner service under the National Health Service, in that coming
from other areas the families could not be put on the lists of local doctors
immediately, being still on the lists of the doctors in the former areas being
regarded up to three months as "temporary residents" and only entitled, locally,
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