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44
DIPHTHERIA.
The method of dealing with diphtheria when there is any reason to suspect danger of
school spread has been modified. Formerly no notice was taken in general by teachers of cases of
illness other than those formally notified as diphtheria by medical practitioners. It has now come
to be recognised that during the prevalence of diphtheria there are very many slight cases which
escape detection and return to school in an infectious condition or continue in attendance throughout
the attack. It is these cases which are responsible for school outbreaks. In accordance with the
resolution of the Council, whenever diphtheria appears in a department, the head teacher is
communicated with and is now instructed that no case of sore throat or suspicious illness, however
mild, is to be re-admitted to school after absence without a medical certificate based upon bacteriological
examination. This prevents the admission into school, between the visits of the school
doctor, of children who otherwise would return in an infectious condition, and for a while disseminate
the disease. In addition the medical officer of health of the district obtains early information of all
such cases from the school, and the grip of the health authorities upon diphtheria is tightened.
Many of the local authorities who provide for such bacteriological examination have welcomed the
arrangement; a few have raised endless difficulties and necessitated unnecessary expense to the public
by reason of the extended absence of the children, under suspicion, which has been required, in
addition to conducing to the out-of-school spread of the disease.
As has been pointed out repeatedly we have been fortunately, of late years, on the waning slope
of a wave of diphtheria incidence covering many years ; there are not wanting indications that we
have reached the trough between two such periodic waves, and it is necessary to consolidate our
forces with a view of being prepared for the recrudescence which epidemiological experience warns
us to expect. Like scarlatina, diphtheria has been more prevalent during the past year, 7,987 cases
occurring at all ages, and 2,645 occurring amongst elementary school children, compared with 6,553
and 1,977 respectively during the preceding year. It has seemed more widely diffused rather than in
definite outbreaks. This is possibly the commencement of a period of increasing susceptibility to the
disease generally ; there is no evidence of increased school prevalence, the proportionate rise amongst
the general population and the school population being practically the same.
The number of schools during the year in which the rule with regard to non-admission of
sore throats during diphtheria prevalence were applied was 39 (94 departments). The number of schools
to which special visits for swabbing purposes were made was 32, the number of cultures taken 803,
and the number of carrier cases detected 68.
MEASLES.

Here it is seen at the expiry of four years from the beginning of the experiment in 10
schools in the closing area 38.5 per cent. were unprotected by a previous attack, while in 6 schools
in the non-closing area 44 per cent. were unprotected. Measles attacked 22 per cent. of the children
in both districts, and 22 per cent. of the children in the non-closing area were left unprotected, as
against 16.3 per cent. in the closing district. Further, with regard to babies admitted since the