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23
But one significant fact should be borne in mind; in spite of the
extreme mildness of the disease in this district last year, when
enquiries were carefully made afterwards, in all the "missed" cases
subsequently detected, there was a history of a sore throat and a
rash on the trunk and limbs. These cases had remained undetected
in spite of the usual symptoms of Scarlet Fever. True, the sore
throat was slight, and the rash was faint, but the conjunction of
these two symptoms is known to most people to be associated with
Scarlet Fever. There is not the slightest reason to believe that the
parents intentionally concealed the existence of the disease. Nor
could the dread of removal to Hospital have influenced them, as in
many instances, the cases could well be isolated at home. Moreover,
every care is exercised by the teachers to detect any case of
infectious disease at school, and testimony should be borne to the
valuable assistance rendered by the teachers. It would be almost
impossible to detect the "missed" cases, but for the assistance
rendered at the schools. Unless the children are very ill, they are
loath to complain, even to their parents, so anxious are they not to be
absent from school. It is difficult to suggest a remedy, as under
existing conditions an enhanced attendance means, not only an
increased grant, but a gain of prestige for the school. The importance
of a high average attendance might be less highly magnified,
and in some districts the practice of giving medals and prizes for a
full attendance has been abolished.
The occurrence of missed cases is not the only factor in school
attendance which affects the spread of Scarlet Fever. There is little
doubt but that the early infection of Scarlet Fever is also one of the
means by which the disease is spread. There is hardly any disease
concerning which opinions have recently more profoundly changed.
It was formerly held that the disease was not infectious until peeling
had commenced, and that the infection was connected with the
desquamation. This theory has been exploded, and we now know
that infection can be conveyed during the earlier stages of the illness.
It is still held in some quarters that until the appearance of the
rash, there is no fear of infection. There are grounds to believe
that the disease is infectious from the commencement of the
sore throat and the initial sickness. Mention may be made again of
the case notified in December, and who attended the Priory School,