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34
1. Overcrowding or large numbers of children in the house,
particularly in view of the close contact experienced by
children during the night. The average numbers of occupants
where only primary cases occurred, were adults 2.4,
children under 15, 2.88. Where secondary cases occurred, the
corresponding figures were 2.36 and 3.9 in the L.C.C. houses
and in other houses 3.88 and 4.44.
2. Infecting case not being removed sufficiently early. Excluding
cases caused by carriers in 62% of houses in which
secondary cases occurred, the primary case was not removed
before the fourth day after the alleged onset. In the houses
where no secondary cases occurred the primary case was
removed in 15% of cases on the first day of illness, in 21%
on second day and 25% on the third day, i.e. 61% were
removed before the fourth day.
Deaths.
20 deaths per 181 cases is a case mortality rate of ll%. Of
these 56% did not come under treatment before the fourth
day after the alleged onset of disease.
Anti-toxin.
As at one time it seemed probable that selection of cases
would have to be made for admission to Hospital, some having
to remain at home, a supply of Anti-toxin was obtained. Its
use has been limited however, to those cases staying at home
at the parents' request, no diphtheria cases having to be denied
hospital treatment.
Schick testing and Toxin Anti-toxin immunisation.
No Schick testing has been practised and no steps taken
towards any scheme for immunising the population. This is
a departure, which in many places, is proving its worth and
no doubt before long will be much more generally practised
than at present. To carry out effectively however, it needs an
intense propaganda campaign and necessitates an ample staffing
of the Public Health Department.
Bacteriological Examination.
334 swabs were examined from this district at the Essex
County Public Health Laboratories.
School.
The Ford's School outbreak was the only one in which
schools played any appreciable part in disseminating the discase.
No schools were closed during the year on account of
Diphtheria.