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of infections, a very small group now in this country, the infection is
introduced by inoculation, the infective agents getting into the body
tissues through a breach in the surface of the skin, or sometimes of the
mucous membrane. Occasionally, transmission is by mediate infection,
which may be remote or recent.
With such a variety of means of spread, the methods adopted to
control transmissions must vary. Then diseases differ very much in
their severity and in their public health significance. To some, virtually all
of us in this country succumb some time or other. There might be, then,
little point in endeavouring to avert an attack. On the other hand, an
attack of, say, measles in the very young might be so serious that every
effort should be made at least to postpone the onset. Then there are
very common complaints which in childhood cause so little disturbance,
but which in the adult may have more serious consequences. While it
would not be suggested that there should be deliberate exposure of a child
to such a disease as mumps or german measles, yet in view of the possible
complications of an attack of mumps in an adult or the effect on her child
of an attack of german measles by a mother in the early stages of pregnancy
attacks of these two complaints in childhood in general cannot be
looked upon as disasters. Whether anything should be attempted,
then, to limit the spread of infection depends partly on the clinical
seriousness of the disease. Another point that must arise in the case
of the less serious of the complaints is whether anything really effective
can be done to control the spread.
These are some of the points which have determined the policy
governing the steps to be taken in regard to the various diseases.
Notification.
The first step in the control of any infection is to obtain a knowledge
of the incidence and, more especially, to learn of the early cases. This
is done by notification.
In 1889, a number of communicable diseases was set out in the
Infectious Diseases (Notification) Act, which was adoptive, that is, it
was not of general application, but could be operative in any district
at the election of the local authority. Ten years later the Act became
generally applicable throughout the country, though London had its own
Acts. In the consolidating Public Health Act, 1936, some small amendments
were made to the list which now includes smallpox, cholera,
diphtheria, membranous croup, erysipelas, scarlet fever, typhus, typhoid,
enteric and relapsing fevers. These are the " notifiable diseases."
A local authority can, with the sanction of the Minister, add to the list of
diseases which are notifiable. In this way, pemphigus of the new-born
has been made notifiable in this district.
The Minister of Health is empowered to take steps to control the
spread of various infections. Under these he has made regulations
which call for the notification of the following conditions:—plague,
cerebro-spinal meningitis, acute poliomyelitis, acute polioencephalitis,
encephalitis lethargica, tuberculosis, puerperal pyrexia, ophthalmia
neonatorum, malaria, dysentery, acute primary pneumonia, acute
influenzal pneumonia, measles and whooping cough.