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case of the more severe of the infectious diseases. For many years
now the procedure in regard to the exclusion of school-child patients
suffering from infectious diseases and from school contacts has been
governed by the recommendations contained in the " Memorandum on
Closure and Exclusion from School " issued jointly by the Ministry of
Health and the Board of Education. For a long time there has been doubt
as to whether the practice of excluding school-child contacts has been a
factor of importance in limiting the spread of infection, and it was
certainly felt that the sacrifice of education involved did not bring about
any corresponding advantage to the public health. An addendum of
the memorandum was issued last year, which recommends a modified
procedure. The provisions were adopted by the Middlesex Education
Committee and so apply to the public elementary schools in this area.
The general effect will be that patients who have suffered from scarlet
fever or diphtheria can now be admitted to school one week after being
freed after home treatment or being discharged from hospital instead of
after a period of two weeks as formerly. In regard to contacts the main
change is that contacts of patients suffering from these two diseases can
be'admitted to school seven days from the beginning of isolation ; previous
practice was to exclude the contact of a home treated case until one week
in the case of scarlet fever and ten days in the case of diphtheria after
the patient had been released from isolation.
Typhus Fever.
Owing to the increased risk to-day of the introduction of typhus
fever into this country, special attention has been given to the steps which
would be taken in the event of an occurrence of a case in this area.
Patients detected in Middlesex would be removed to the Hornsey,
Finchley, Wood Green and Friern Barnet Hospital or to the Uxbridge
Isolation Hospital, by conveyances provided by these institutions.
Disinfection of the premises would be necessary, surveillance of the
contacts and special precautionary measures would need to be taken by
any staff dealing with such infectious cases.
DIPHTHERIA.
Incidence.
67 notifications were received during the year, though in a number
the diagnosis was subsequently amended, mostly to tonsillitis. The
corrected figure of 51 in a population of — gives a rate per thousand
population of — (the figures for the years 1934 to 1941 were 0.6, 0.58,
0.22, 0.54, 0.28, 0.41 and 0.20).
Three were bacteriological cases only, the patients giving positive
nasal swabs.
Secondary infections occurred in two households.
Of those proved to be diphtheria, 26 per cent, were under five years
of age, 36 were of school age, and 38 per cent. were over 15.
Place of Treatment.
All but four of the patients were admitted to the Harrow Isolation
Hospital, two of these four being removed from general hospitals outside
the district and two being treated at home.