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believed. We have, therefore, been able to reduce the exclusion
period in the case of contacts of many infectious diseases, especially
the milder type of infectious disease such as scarlet fever and
measles. Needless to say, of course, the period of exclusion
of contacts of such diseases as poliomyelitis, where the duration of
infectivity is still not clearly known and where the disease itself can
be very serious, remains more or less as before. Broadly speaking,
the Medical Officer of Health is given a wide latitude in the matter
of school exclusion. I have referred to this matter on several
occasions in submitting detailed reports to the Public Health Committee,
and will continue to keep the Committee informed of any
changes in policy. Our present system aims at obviating unnecessary
loss of school attendance, while adopting such safeguards as are
obviously necessary. It is certainly a fact that our present policy
has not resulted, so far as we know, in any increase in infectious
diseases generally or in the spread of outbreaks or epidemics in
schools.
Diphtheria.
For the ninth year in succession, no case of diphtheria was
notified in the Borough. The last death took place approximately
fourteen years ago.
These figures would appear to indicate that diphtheria can no
longer be considered a serious menace. Or perhaps it would be more
true to say that for the time being, diphtheria has lost its terrors.
The fact that several cases of diphtheria have been notified from
various parts of the country within the past year, and that some of
these cases were extremely serious, points to the fact, however, that
the possibility of diphtheria returning as a major infectious disease
can still not be dismissed. Every now and again we receive a
laboratory report which suggests that the causative organism may
be the diphtheria bacillus. We also hear of cases admitted to an
isolation hospital which clinically resemble diphtheria. Up to the
present, none of these cases has been substantiated. But we know
only too well that, should the rate of immunisation among children
fall to any appreciable extent, we might at any time be faced with
quite a serious problem.
Although immunisation is carried out in Southgate by the
Middlesex County Council, this might be an opportune moment to
refer in some greater detail to our immunisation programme. During
1956, our policy was altered only in minor respects. Thus, we
decided to use the latest available type of diphtheria antigen (formol
toxoid), this antigen having proved both efficient and safe. We also
carried out most of our immunisation by the combined method,
i.e. pertussis (whooping cough) and diphtheria, thus limiting the
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