View report page

183
If we exclude secondary oases occurring within the limits of the incubation
period (i.e., within 8 days after the occurrence of the primary case)—it
will be seen that, of all the school children excluded as contacts, only three
developed scarlet fever. Of these three, one was secondary to a primary
case which had been removed to hospital.
From the records available I find that, under the existing regulations,
over 6,000 attendances were lost by children excluded from school as
scarlet fever contacts during 1932. So that—as a safeguard against the
possible conveyance of infection to school by three contacts who later
became infectious—over 6,000 attendances were lost in one year in respect
of only one (scarlet fever) of the notifiable infectious diseases.
On dealing in similar fashion with the scarlet fever records for the first
10 months of 1933, the following are the relevant figures:—
Number of notified cases 536
Removed to hospital 348
Treated at home 188
Number of secondary cases of school age 6
Number of school attendances lost by contacts (approx.) 11,000.
General Observations.
In the case of scarlet fever, as in other infective processes, there are
from time to time great fluctuations in incidence and severity. Although
scarlet fever—a generation ago—was a very fatal disease, over a fairly long
period the mortality has been almost negligible. Nevertheless its isolation
and treatment still involves the expenditure of much public money and
causes serious interference with the education of children.
The measures taken for the treament and control of infectious diseases
have tended in the past to become established practices and fixed traditions,
and that in spite of the growth of medical knowledge as to the particular
channels of infection. Our methods of disease prevention call for constant
and critical re-consideration as to their necessity and expediency. For
example, four years ago the traditional routine steam disinfection of bedding
and clothing from infected houses was discontinued in this area: and instead
of an increase in the number of secondary cases since that time we
have had a decrease. Now we have the Ministry of Health recommending
(Circular 1,311, March, 1933) that Local Authorities should consider as to
the advisability of continuing their routine methods of disinfection.
Conclusions and Suggestions.
The annual loss of school attendance due to the routine exclusion of
contacts is enormous, and I am of opinion that it is in great measure
unnecessary in the interests of public health.
By confining the exclusion of scholars to the incubation period of the
disease (e.g., a week in the case of scarlet fever and diphtheria), parents
will be more willing to agree to home treatment; thus permitting of the
use of available hospital beds for more serious cases of infection, (e.g.
measles).