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20
Diphtheria.
A. Advantage of Bacteriological Examination.
"42. The examination of the throats of 'contacts,'
"whenever practicable, by bacteriological means, is a most
"important aid to precautionary measures against the
"spread of diphtheria. If a positive result is obtained in
"the case of children showing no evidence of diphtheria,
"the presence of some measure of infection must be
"assumed, though it will not be advisable to insist on the
"removal of such patients to an isolation hospital.
"it is recognized 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 child"ren
who have been absent without known cause, or who
"show evidence of pallor, enlarged glands, or sore noses."
B. Rules for Exclusion of Individuals.
(1) As regards each child attacked by the disease.
"43. (a) When treated in the Isolation Hospital the
"patient should, when practicable, be detained until three
"successive swabs taken on different days have given con"sistent
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 diphthe"ria,
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 subse"quent
abstention from school attendance as above should
"be enjoined."
(2). As regards children living in infected houses.
"44 (a) When the patient has been removed to the