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be assumed, though it will not be advisable to insist on
the removal of such patients to an isolation hospital.
.It is recognised that in many sanitary districts
arrangements do not exist for such examinations; but it
has been thought better to set forth the line of action
commonly adopted in the best organised sanitary districts'
Clinical examination of contacts and other
children often throws valuable light on the origin of
outbreaks of diphtheria. Particular attention should
be paid to children who have been absent without known
cause, or who show evidence of pallor, enlarged glands,
or sore noses'.
Rules for exclusion of individuals'
(1) As regards each child attacked by the disease:—
.(a) When treated in the Isolation Hospital the patient
should, when practicable, be detained until three
successive swabs taken on different days have given
consistent negative results' These swabs should not
be taken until at least 48 hours have elapsed since
the last application of any disinfectant to the
throat. In view of the debility left by an attack of
Diphtheria, and the possible return of infectivity
in the secretions of the nose or throat a notice should
be sent to the teacher stating that the child should
not return to school for four weeks after return
home.
.(b) When the patient has been treated at home three
successive negative swabs should, when practicable,
be obtained as above; and after disinfection of the
patient and his rooms and belongings, the same
period of subsequent abstention from school
attendance as above should be enjoined..
(2) As regards children living in infected houses:—
.(a) When the patient has been removed to the Isolation
Hospital the teacher and the parent should be
instructed to keep all children living in the same
house away from school during the next two complete
weeks, or even longer, unless these children
have been cleared by negative result of bacteriological
examination.
.This interval is desired owing to the frequent
occurrence of slight cases of diphtheria and
.carrier. cases'
.(b) When the patient is treated at home no other
child from the same house should attend school
while the patient is infectious, nor for four weeks
afterwards'.
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