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took place between November, 1952 and October, 1953. A report has now been
presented to the main committee which contained data on the source and origin of one
year's notifications in London. Nearly a half of the cases notified had a clinical illness
which was confirmed bacteriologically, less than a tenth were symptomless carriers, and
two-thirds of the cases were in outbreaks of two or more associated cases. The secondary
attack rate increased steadily with increase in family size above three persons. Children
under 15 were more likely to give rise to secondary spread, and more susceptible to
secondary spread than those over 15. There was also a suggestion that the child under
five gave rise to more spread than the older child, but this was less certain. Secondary
spread was greater in homes where cleanliness had been assessed as poor than in other
houses. Isolation of the primary case by removal to hospital appeared to have no effect
on secondary spread. A clear association was shown between the severity of the primary
case and the resulting spread ; in particular it was found that very little spread resulted
when the primary case was a symptomless carrier. Trials of the use of sulphonamide to
limit the spread of the disease in day nurseries were carried out at the same time;
success or failure appeared to depend more upon the number of children involved in the
first wave of cases than upon any other factor ; where the infection was widespread
sulphonamide appeared to present few advantages.
The inquiry produced a great deal of factual information on the above and other
aspects of the disease. Of particular interest was the finding of very low secondary
family attack rates following exposure to symptomless excreters. Whether or not this
can justify some relaxation of the customary practice of excluding such cases from day
nurseries is a matter that can only be decided by practical trials in this field.
Enteric
fevers
The number of notifications of enteric fevers in the year (49) showed little change
from the previous year (45). There was once again an absence of substantial epidemics.
Some of the infections occurred among persons recently returned from visits to the
continent, but these formed only a small proportion of the total. The principal method
of attack on this type of infection is an intensive investigation into the circumstances
of origin of each individual case with a view to bringing to light the healthy carrier of
infection.
Erysipelas
The number of notifications of erysipelas was 368 compared with 408 in 1953, and
the number of deaths was one compared with three in 1953. The number of notifications
has been decreasing steadily for many years. It is known that the notification of erysipelas
is defective to an indeterminate degree and it is therefore not possible to say whether
any significance should be attached to this decrease in recent years. It is noteworthy that
another streptococcal disease, namely, scarlet fever, has not shown the same tendency
towards diminishing incidence.
Food
poisoning
There was a slight diminution in the notifications of food poisoning, 1,060 cases
being notified compared with 1,269 in 1953. The sex and age distributions were :
Age Males Females Total Attack rateper 1,000
0-4 146 112 258 1.10
5-14 54 46 100 0.24
15-44 178 332 510 0.35
45-64 63 84 147 0.18
65+ 14 31 45 0.12
455 605 1,060 0.32
Influenza
The figures show a male excess in childhood and a female excess in adult life. The
age specific attack rates would appear to suggest that this condition is notified more
frequently in pre-schoolchildren than in schoolchildren and adults.
There were only 83 deaths during the year attributable to. influenza, this being the
lowest figure recorded since 1948. The influenza epidemic in the early part of the year
20