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24
secondary to a school case. But this assumption cannot be
made, as cases of outside infection occur amongst children
not attending school.
Further evidence of this small effect of schools in the
spread of infection is the fact that there is little change of
incidence of infection occurring during the school holidays
Further, there were some cases infectious while attending
school, but little damage resulted. Of four cases attending
school until desquamation was obvious, only once did another
case of Scarlet Fever occur, and even then not until the tenth
day following the exclusion of this child.
Of the cases occurring secondary to home treated cases
there were 28 infecting cases, in 11 of whom onset was within
8 days of the diagnosis of the primary cases and. therefore
would have been excluded from school. Of the other 17 cases
whose onset was after 10 days of the onset of the primary
cases, six were patients where diagnosis of the primary case
was missed, and one was the case of a mother nursing her
infected child. That leaves 10, or one third of the secondaries
at home which occurred outside after exclusion period of ten
days. Assuming that these ten cases are of school children
who attend school and infected in the same proportion as the
original primary cases, they would then give rise to 23*10/265
cases, or one additional case of Scarlet Fever. Actually,
course, the risk would be less than this for the reasons:-
(a) That those cases occurring in the schools include those
which are secondary to primary cases which are missed
for long periods, and are, therefore, at large while
infectious, and
(b) That the secondary cases are diagnosed earlier, even
though to only a slight extent than the primary as
evidenced by the Doctors being called in earlier.
There is a further point—so far as the home contacts
themselves are concerned, if they are attending school, there
is less likelihood of their coming in contact with the patients,
not only for the period they are at school, but also for the rest
of the time.
On the grounds given above, a suggestion was made to
the Essex Education Committee that they should agree to a
shorter period of exclusion of contacts of the home treated
cases. The Committee, however, did not adopt the suggestion
with the result that some one thousand school weeks are
sacrificed in order to save a possible Consequent additional
case of scarlet fever.