WHOOPING COUGH.
In a child under seven, a severe cough should always be regarded as possibly whooping-cough, although no “whoop” has yet been heard.
2. The notification of all cases of infectious diseases to the medical officer of health, is clearly a means to an end, that of securing that the preventive measures to be next named are effectively carried out.
3. Means for the production of an artificial immunity. This is only practicable at present for two diseases of this country, small-pox by means of vaccination (page [293]), and a temporary immunity against diphtheria by a dose of antitoxic serum (page [299]). Apart from these means, any measures for improving the health of a child tend in the same direction. Enlarged tonsils, “adenoids” at the back of the nose (causing the child to snore at night and to breathe through his mouth), discharges from nostrils or ear, and similar conditions should receive early medical attention.
4. Isolation: preventing the conveyance of the contagium from the sick to the healthy.
5. Disinfection, i.e. destruction of the contagium of the disease.
The Infectious Disease (Notification) Act, 1889, and the corresponding London Act of 1891, impose a dual duty of notification (a) on every medical practitioner attending on or called in to visit an infectious patient, as soon as he becomes aware of its nature; and (b) on the head of the family to which the patient belongs or the nearest relative. The intimation must be sent by each of these to the local medical officer of health, the practitioner being paid a small fee for his trouble. Usually notification by the householder is only enforced when no doctor is in attendance. The diseases to which this Act applies are small-pox, cholera, diphtheria, membranous croup[11], scarlet fever, erysipelas, and the fevers known by any of the following names: typhus, typhoid, enteric, relapsing, continued or puerperal. The list of notifiable diseases may be extended by resolution of the Local Authority.
The enforcement of notification is most important for the public health. (a) It enables the medical officer of health to take immediate steps to prevent the spread of infection, by enforcing proper isolation of the patient, efficient disinfection, and by preventing the attendance of children from infected houses, at school, etc. (b) It enables the links of evidence connecting a series of cases to be identified, e.g. cases due to a common milk supply, or attendance at a particular school. (c) It has a valuable educational effect on all concerned in the cases.
ISOLATION.
Both the patient and his attendant need to be isolated in diseases like scarlet fever, diphtheria and small-pox. The rule is less absolute in enteric fever. In the following description the standard of requirements taken is that of the most dangerous infectious disease, small-pox. The first point to decide is whether the patient may be safely isolated at home. For small-pox this ought never to be allowed in a town. For other diseases, this may be permitted, if the following conditions can be fulfilled.