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1928
25
is based upon the assumption that endemic infections of children
are almost entirely spread by droplet diffusion, and that in the
vast majority of instances all other means of spread can be
ignored. There are rare instances where articles of clothing
have been the means of spreading infection. These instances
have occurred in the early stages of illness, when the patient
has been sick and the articles soiled have been packed and sent
away, or the discharge from the nose and the mouth have been
wiped by handkerchief, folded, and sent to a laundry. But the
contact, unless he is a carrier, or incubating the disease, is no
more concerned with the spread or infection than is the desk,
and probably the incubator, if at any time the is capable of conveying
infection can only do so for very short periods. There
is no new evidence to upset the time-honoured doctrine that
diseases are not catching during the incubation period. But a
contact may be a carrier, and if he is, he is a danger. It is only
in diphtheria that the question of whether a person is or is not.
a carrier can be answered definitely. Unless the case can be
proved to be a carrier, it seems unnecessary to exclude contacts
from school upon a supposition which is questionable; especially
in view of the fact that if there is any danger at all, it can be
controlled better at school than anywhere else.
In Acton, the method of dealing with contacts is different
from that which has hitherto been adopted in most districts. As
far back as 1922 we abandoned the procedure of excluding
Diphtheria and Scarlet Fever contacts from school attendance for
a certain time placing them, as it were, in quarantine. Formerly
it was the practice to exclude from school for a fortnight all
children from a house where a case of Scarlet Fever or Diphtheria
had been notified. This period of exclusion represented the
maximum period of incubation. In practice, it is found that if
a second case of Scarlet Fever or Diphtheria occurs in a house,
it happens in the vast majority of instances within a couple of
days of the first one. Occasionally at the end of two or three
weeks, we found that one of the contacts was peeling; during
the quarantine period he had suffered from a slight sore throat,
and he had had a doubtful rash. When he was examined at the
end of his quarantine period the initial symptoms had subsided,
but the skin had not commenced to peel. Such cases would be
more likely to be detected under our present procedure. Now,
all the contacts are examined on the day following the removal
of the patient to the hospital. If they are free of symptoms they
are allowed to return to school, where they can be kept under
observation. At the end of a fortnight they are again examined.
With Diphtheria contacts, we are, of course, on safer
ground, because the specific germ of the disease has been