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similar institutions will break the cycle of infection and reduce the incidence".
During 1963 the incidence of dysentery in Southwark although reduced to
415 cases, was still too high. Some of these were institutional cases and
represented to a very large extent infection introduced from other parts of
London. The symptoms of dysentery are frequently not severe. Many of the
cases referred to here had no symptoms and were discovered as the result
of bacteriological investigation. When all this has been said, however, there
remains inescapable evidence of factors operating in the community which
favour the spread of this alimentary infection. Bacilliary Dysentery is more
infectious than typhoid but there are very many similarities in the mode of
spread of both of these diseases. In both cases the reservoir of infectionis
man itself, the causal organism being passed in his excreta. The lesson from
Aberdeen therefore cannot be ignored. By increased and constant attention
to food and personal hygiene not only will the incidence of dysentery be
reduced but an important step will have been taken in protecting the community
against the more serious disease, typhoid, should it ever be introduced. A
community which is vulnerable to dysentery will be vulnerable to typhoid
should it appear. More attention must be paid to the washing of hands after
toilet and before meals, or before handling food. The advice was continuously
tendered by officers of the Public Health Department to mothers, food
handlers and school children, throughout the year.
On the 10th June 1963 a case of diphtheria came to notice and, in
collaboration with the Divisional Medical Officer of the London County
Council, nose and throat swabs from a large number of school and home
contacts were taken for examination. As a result four cases and seven
carriers were immediately disclosed. Investigation of a wide circle of home
contacts continued during the holidays and on the resumption of school a
further survey was undertaken. In all thirty persons were found to be harbouring
the organism of diphtheria and eight of these were considered to be
clinical cases. Those infected resided in the south western part of the
Borough and multiple cases occurred in several families. Two of the individuals
concerned were over school age, five were under school age,
while nineteen of the remainder attended one school. The four other children
were spread over three different schools.
All cases and carriers were admitted to hospital immediately they came
to notice. Doctors practising in Southwark, and the appropriate hospitals were
informed of the presence of diphtheria in the Borough on the second day of
the outbreak. With the authority of the Chairman of the Public Health
Committee the local press were told of the position in order that parents
might be alerted to the importance of their arranging for any of their children
who might be off colour to be seen by the family doctor, and to urge them
to have their children's immunisation brought up to date.
The diphtheria immunisation state of the children resident in Southwark
is well up to average. On the other hand the immunisation record of the actual
cases and carriers were found to be unsatisfactory. They had never been
immunised or had not completed an adequate course of injections. As a
result there was no wide-spread outbreak in the schools attended by these