Severe Dermatitis and "Biological" Detergents

thought it might be of interest to note that during the peak of the outbreak in the hospitals of the area the usual alerts were sent out to all general practitioners, health visitors, and district nurses. Only two cases were reported from the community and confirmed at subsequent examination. However, in the old people's homes for which I was responsible nearly 15% of the residents were affected (out of 325). These were grouped in two homes and had the typical lesions described. Very vigorous investigations were conducted by the public health department of Lancaster city, but no conclusive findings were established in the foodstuffs of the area. However, it has still to be explained why this particular outbreak was mainly confined to closed communities. There was only one clue that did not yield any result, which was that certain wholesalers supplied certain foodstuffs to the hospitals described and to the old people's homes. There was no other link established. Apart from the interesting suggestion that these outbreaks may be linked with the ambient temperature, I am still not satisfied in my own mind that there was not a common food-borne agent which acted as a catalyst for the outbreak. It should perhaps be pointed out that farmers only spray in certain kinds of weather, and this might well be linked with wholesale supplies. It would be very difficult to establish the presence of an agent which had contaminated one batch of food if that batch had been used up several days before the outbreak. However, the explosive nature of the outbreak and its confinement to institutions with common wholesalers who did not supply the community still points to a foodborne origin.-I am, etc., H. P. FERRER. Department of Preventive and Social Medicine, University of Manchester.