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76
SCARLET FEVER—SCHOOL EXCLUSION AND
HOME TREATMENT.
During the year 1933 there occurred in Leyton an exceptionally
widespread epidemic of scarlet fever. Even after the most rigorous
selection of cases for admission, it was quite impossible to provide
hospital treatment for all cases in which the home circumstances
were not suitable for home treatment. On the other hand, there
were many parents who were able and willing to provide homo
treatment, but they objected because it meant the exclusion
from school for six weeks of all school children in the same house,
which may include more than one family. It was therefore evident
that the Education Authority's "Regulations for the Exclusion
from School on account of Infectious Disease" provided a barrier
in the way of more widespread home treatment, even when such
treatment could be provided with relative safety to patients and
immediate contacts.
In December, 1933, I submitted to the Public Health and
Education Committees a special report from which the following is
an extract:—
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 treatment 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 reconsideration 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.
Conclusions and Suggestions.
The annual loss of school attendance due to the routine exclusion of
contacts is enormous, and 1 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 the more serious cases of infection.
I propose to redraft the existing "Regulations for the Exclusion of
Children from School " in such manner as to interfere as little as possible
with school attendance while safeguarding against the conveyance of infection
in accordance with modern ideas regarding epidemiology.
As far as I know, there is no area in the country where school exclusion
has been dispensed with to such an extent so far; but, after giving the
matter serious consideration from all points of view, I am convinced that
such action has much to commend it both from a public health and from
an educational point of view.