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not be considered an extensive outbreak, we have already
had to admit many of our patients to the hospital of a
neighbouring authority, and this too, at a time of the year
when ordinarily, infectious disease is not prevalent. It seems
inevitable that when the incidence rises as it normally does
throughout the country towards the end of the year, that this
shortage will again be felt. On this occasion the authority
fortunately had accommodation. When our numbers start
rising at the end of the year, so will those of other authorities
and they might not then be able to admit our cases."
Distribution of the Disease in District.
Since April there have been 157 cases notified. Of these,
occurring in the L.C.C. houses, were 81 primary cases (of which
6 were included in the Ford's School outbreak). In the other
houses were 30 primary cases (of which 19 were accounted for
in this outbreak). In the area there are 15,000 children under
15 living in the Estate houses and 2,500 in the other. Considering
all primary cases it is seen that there is a relatively smaller
incidence amongst the Estate houses. Deducting those cases of
the school outbreak, however, leaves a figure of 75 compared
with 11, i.e. a ratio roughly the same as the ratio of the child
population in the two sets of houses. If there is any risk of
increased incidence of Diphtheria in the L.C.C. houses due to
the aggregation of large numbers of children, that same risk
must apparently be reflected to the occupants of the other
houses.
Secondary Cases.
There were 33 instances of cases secondary to a clinically
recognised case, and 8 of cases caused by carriers. Where more
than one case occurs in a house it is often impossible to say
whether the third was infected from the primary source or from
the second case. These secondary cases were divided out as
follows:—
1. L.C.C, Estate.—15 cases in 8 houses (1 in three houses, 2
in 4, and 4 in 1 house), and in addition in
three houses two cases were infected by a
carrier.
2. Other houses.—18 cases in 8 houses (1 in 5 houses, 2 in 2,
and 9 in 1) and in addition in 1 house 2 cases
were probably infected by a carrier.
Of the possible causes for this large proportion of secondary
cases two will be considered.