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One of the waves of gastro-enteritis preceded and another coincided
with the outbreak of typhoid, but clinical diagnosis was facilitated as
almost all cases of the latter commenced with constipation, diarrhoea
developing at a much later stage.
An investigation into a comparatively mild, though fairly widespread
outbreak of gastro-enteritis in a large private school in the District
earlier in the year suggested that the infection was probably air-borne,
being from boy to boy rather than from a common source, a feature
which repeated itself in later outbreaks. Unfortunately no bacteriological
findings are available, and owing to the short length of illness
in most cases, specimens were not easily obtainable. In view of the
number of cases of dysentery found in surrounding Districts, however,
it is probable that a number of cases of unrecognised dysentery due to
Sonne's dysentery bacillus were included in the local outbreaks.
THE CONTROL OF INFECTIOUS DISEASE.
While a perusal of the foregoing will illustrate the place of isolation,
disinfection, etc., in the limitation of infectious disease, only 4 secondary
cases having occurred in the same houses as primary cases during the
year, it is increasingly appreciated how inadequate these measures
invariably are. With diseases such as diphtheria, in which a definite
proportion of the general population are carrying virulent germs, although
apparently healthy, segregation of those suffering from the disease can
only be partially successful in preventing its spread. It is this factor
which has made the recent wave of scarlet fever so difficult to control,
mild and missed cases with inconclusive symptoms, e.g., streptococcal
infections causing no rash, being potential sources of infection.
One of the measures in which most hope for the future lies is
artificial immunisation. Unfortunately in a number of diseases the
immunising agent has yet to be discovered; in others the number of
different strains of the causal organism increases the difficulty of immunising;
in yet others the immunity which can be created artificially is
so short lived as to make the question of the general use of such
measures doubtful or unwise. Diphtheria immunisation has now been
widely used for years, is very effective, and usually lasts for a considerable
time, hence, especially as the disease which is thus prevented or reduced
in severity is normally a very serious infection, the question of accepting
the free treatment offered to all pre-school children should be very
carefully considered by all parents.
IMMUNISATION.
At the present time the facilities at the local Immunisation Clinics
are limited to inoculation for the prevention of diphtheria. Arrangements
are still in force whereby cases in which there are special reasons
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