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70
Some of the channels along which Scarlet Fever is spread
remain obscure, but the opinion is becoming more universally
held that the chief infecting material resides in persons, and not
in things. Our methods may have to be changed, as our knowledge
of the etiology and epidermiology of Scarlet Fever increases.
Our procedure at the present time is based on the assumption
that the spread of the disease in schools takes place under three
conditions.
Firstly, a certain number of those who have suffered from
Scarlet Fever remain intermittently infectious for prolonged
periods. These are the "infecting" cases which give rise to
"return" cases, and they also probably give rise to a certain
proportion of the school cases where the source of infection
remains untraced. What the precise conditions are under which
they continue in an infectious condition remain a subject of doubt
and debate; but in a large proportion of the "return" cases in
houses there is an abnormal condition of the mucous membrane
of the nose and throat of the alleged "infecting" case. In some
instances the patient develops a discharge from the nose or ear
immediately on his return home from the Hospital. In other
cases an enlargement of the tonsils and adenoids is present. In
the report of the Medical Officer of Health an instance is given
of the cessation of notifications from a certain area coincident with
the removal of tonsils and adenoids in such a case. Basing our
action on this experience, every convalescent case is examined
before resumption of school attendance, and if any abnormal conditions
of the nose and throat exist, an endeavour is made to have
this abnormality remedied before the child attends school. If
there is a sore present inside the nose, or an unhealthy discharge
persists from the nose, the child is kept out of school and instructions
given for its treatment. If there is an ear discharge present
or the tonsils and adenoids are enlarged, an operation is advised.
These children are noted and kept under observation, and
are borne in mind as a possible focus of infection.
Secondly, there is reason to believe that persons coming in