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* Same family.
Instructions to Teachers in Scarlatinal Outbreaks.—A circular is now sent
out as soon as a school comes under observation for scarlatina, asking the head teachers
to pay spacial attention to the care of the children in the classroom in which any child,
who subsequently develops scarlatina, has shown any indisposition whilst at school, or where
two cases have occurred within a period of three weeks. They are asked to enter on a list of
absentees th3 names of all children absent for one day or more through illness or indisposition,
and also all excluded for scarlet fever in the house, with dates of last attendance, nature
of indisposition and date of return to school. The teacher is directed to make special enquiries
about any case of sore throat. The names of children absent from other causes than illness
(weather, no boots, holiday, etc.) are entered on another side of the absentee sheet. "Where the
teacher does not carry out these requests thoroughly, or is perhaps not reliable, and frequent visits by
the Medical Officer are out of the question, closure of an infected room may in some cases be desirable.
Such was the case recently in one classroom in an infants' school. Two cases occurred in the Easter
term ; one of these on return in the summer proved an almost certain source of infection, though
no signs of aural or nasal discharge or of any catarrh could be discovered. Four of this child's
associates contracted the disease within five days of his return to school; one was his playmate
out of school. The infecting child was then isolated and there was no need to close the room.
No further cases occurred in this room for three weeks, but scarlet fever was very prevalent
in the district. Next, five children failed almost contemporaneously within three days. Four
of them, however, lived in the same street—the street in which two of the previous cases had
occurred, and one of them was secondary to her younger brother, and all were probably contracted
out of school. Of these six cases in the same street four of the affected families lived within three
doors of each other and in these houses there were several other secondary cases, so that the school
source of infection is at least open to doubt, even though in the present case a larger number of cases
than usual occurred in one classroom. Of this second series of cases, four were notified and removed
to hospital at once, but one returned after the Whitsun holidays, contrary to definite routine instructions,
having been absent for several days previously with sore throat. On his return he infected three children
and one suspicious case within two days. Then he was discovered and notified. If the classroom had
been closed he would not have been discovered, and the Medical Officer of Health would have been
without useful information. Again, there was a lull for ten days, but scarlet fever still prevailed in the
district. Then a fresh case occurred in the same classroom (source not traced—possibly out of school).
The child showed symptoms of indisposition in school and infected two cases at intervals of two and
nine days respectively. After another interval a fresh source of infection arose (probably not at school,
as this room was under medical supervision almost daily), and gave rise to three secondary cases. The
room was closed for disinfection on two days, but this served to allay the anxieties of the teachers
rather than to have any deterrent eSect on the outbreak. It is difficult to say, even after the event,
whether closure of this room at any period of the outbreak would have served any useful purpose, but