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infrequent, it had become well established before the first cases were
notified. Some 78 cases distributed among 50 households occurred either
among the children and staff of this school or among the domestic contacts
of the school children. The main lines of preventive action were
concentrated on the school which was the chief factor in the outbreak
and they included the following:—
The imposition of a strict code of personal hygiene in the school.
All kitchen staff and kitchen practices were scrutinized, the
latter being amended as necessary to ensure there was no risk
of transmission of the infection through food or utensils.
All W.C. seats, chain handles and W.C. door-knobs were
swabbed with disinfectant three times a day.
Insistence on every child or member of staff rinsing their hands
in disinfectant solution after visiting the toilet and the washing
of hands before dinner.
New absentees from school who presented suspicious symptoms were
visited and arrangements made for specimens from them. All were
excluded from school until the results of the examination of the
specimens were known.
The practitioners in the district were informed of the position by
letter and a suggested practice to ensure co-operation and liaison
was made and observed.
Children were allowed to return to school only after a negative
specimen report, provided they were symptomless. In the case of the
one food handler, three consecutive negative reports were obtained.
In this way the outbreak was brought under control and a sharp
reduction in the new cases brought about in the course of a fortnight,
but as in other outbreaks, odd cases continued to occur for several weeks
and a few, although recovered from symptoms, continued to excrete the
organism for a week or two longer than the average which were bacteriologically
positive for about ten days.
A further 12 cases occurred in the second quarter of the year as
isolated domestic outbreaks in different parts of the district, and were
unassociated with the Barrow Hedges outbreak. These too were due to
the Sonne organism.
The last seven months of the year was free from this infection as
far as the resident population was concerned, though a single case
occurred in a hospital patient during November.
Scarlet Fever
The incidence of scarlet fever at 76 cases was approximately half
that of the year before. As with Sonne dysentery, the very mildness of
the illness creates its own problems in relation to its control. One has to
contend with a sense of unimportance on the part of the profession and
the public alike. As a result it is difficult to maintain the view that being
an infectious condition, certain precautions are still necessary and that
some degree of restriction must be imposed both on the patient and his
contacts. With the decrease in the virulence of this infection, these restrictions
have been progressively relaxed over the years and unless complications
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