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the development of congenital defects in a child born to a mother who
has suffered from german measles in the early stages of her pregnancy.
Contacts are not now excluded from school.
Influenza
Influenza as such is not notifiable so there is no direct indication
by this means of its prevalence. Other guides are not true indications
of the incidence. For instance, influenzal pneumonia is notifiable, but
the extent to which this occurs depends not only on the prevalence of
the primary influenza but also on the character of the particular invasion,
as a mild type of influenza might be very prevalent but lead to few or
no cases of influenzal pneumonia. In the same way the returns of those
whose deaths have been ascribed to influenza, although when they occur
they indicate there was some influenza, do not give any real indication
of its true incidence. Local authorities learn of the prevalence of this
condition from what is gathered about the absence from this cause of
those at nurseries, or schools or places of employment and from
information from health visitors and general practitioners. This districl
seemed to escape any invasion from influenza in 1954. There was in
fact only one death ascribed to it, and only 10 notifications of influenzal
pneumonia.
TUBERCULOSIS
Notification
Any patient notified as suffering from one of the acute notifiable
conditions will probably have contracted the infection about the time
the case was notified. Because of the very indefinite onset of tuberculosis
this is not the case in this disease, and a patient recognised to-day to
be suffering from the infection may in fact have contracted it some
considerable time earlier. For this reason then the notifications received
in any one year do not necessarily indicate the number of persons who
in fact succumbed to the disease in that year. This aspect is perhaps
not so important from an epidemiological point of view when the patient
has in fact lived in the district for long enough for the illness to be
contracted in the first place while he was resident there. The position
is different though when a person moves to a new district when he is
already suffering from the infection which has not up to then been
recognised. Even though the district is counting only the newly notified
cases, when such a case is notified for the first time in the new area,
that area accepts that case so that the number of cases of tuberculosis
contracted by those living in the district while they are living there is
swollen. This increase could be quite substantial where there is much
movement of population which will occur in a growing district. Another
complication arises in the case of those who move into the district
suffering from an attack which has already been recognised, the patient
having in fact been notified in the other district. The notification
regulations require a doctor to notify any patient suffering from a notifiable
disease to the Medical Officer of Health of the district in which the
patient is residing. When such a patient then moves into a new district,
the doctor under whose care he comes should notify the case. This