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sent. On further examination of the child contact at the end
of the incubation period of the disease, if there are no signs
suggesting that the child is incubating the disease, the parents are
advised as to when the contact may return to school and a notice
to this effect is sent to the head teacher.
At one time the exclusion of contacts was carried out to a
far greater extent than obtains to-day, many firms and authorities
insisting on the exclusion of adults in circumstances in which it
was most unlikely that infection would be spread. A more moderate
policy, however, is now generally adopted: for instance, the
policy of the Post Office is now tending towards abolishing
quarantine, permitting contacts to remain at work under medical
supervision when they are in good health. There is now a
tendency to take a similar line in regard to school children and
some authorities have modified their regulations to permit the
attendance of contacts at school, relying on the examination of
each contact on entry as a precaution and excluding those contacts
who show the slightest signs of their possibly being incubators of
the disease. The operation of such a rational policy should save
much waste of school time.
Measles and whooping cough are not notifiable in this district
and particulars in such cases are received only from the head
teachers' weekly returns. As there may be children under five
years of age in the house in which a school child is suffering from
one of these complaints, visits are paid to all these homes on
receipt of the head teacher's intimation and advice given,
particularly regarding precautionary measures to be taken.
Incidence. DIPHTHERIA.
112 notifications of diphtheria were received during the year,
the diagnosis, however, being revised in 14 of these cases to some
other condition, of which the most common was tonsillitis. The
figure is a sharp rise on that for the preceding year but is well
below the national rate, the incidence of diphtheria cases being
only 0.54 per 1,000 population compared with a figure of 1.81
for the country as a whole. This is the eighth consecutive year
in which a low incidence has prevailed. While the district may
be considered fortunate in having these low rates, the absence
of the disease entails a loss in those sub-infective doses by which
the immunity of each individual member of the population is
raised and so leads to the development of a state of low herd
immunity in the population. In such circumstances the district
becomes ripe for an explosive outbreak. In the absence of cases,
or carriers who may be related to cases, the herd immunity of
the population can be raised only by artificial immunization.
Secondary infections occurred on five occasions. In three
mstances the first case was unrecognised and the individual patients
gave rise to one, two and three infections. In each of the other two
D