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(b) Because it is known thatthe infection may attach itself
to, and be conveyed by, the throat secretions or the clothes
of a person living in an infected dwelling, even although
the person himself remain unaffected."
There is every reason to believe that the danger formerly
attributed to the conveyance of infection on the clothes of healthy
persons has been considerably overestimated. It is, of course,
a possibility; but if it constitutes a real danger, surely the danger
is as real in the case of adult contacts, on whose movements no
restriction is placed—for the hsemolytic streptococcus, as far as I
am aware, shows no predilection for " attaching itself " to the clothes
of the school child in preference to those of younger or older members
of the family.
Although excluded school contacts may not go to school, they
are free to play in the streets and frequent other public places as
much as they choose; and they generally enjoy much more than
their usual amount of freedom out of doors due to the fact that
they are too much "in the way" of the already harassed mother,
who acts generally as sick-nurse. If the infectious patient is isolated
satisfactorily in the home, there should be no need to exclude
school contacts for more than a week. If, on the other hand, home
isolation is unsatisfactory, the patient should be removed to hospital.
In any case, the long period of exclusion from school of
contacts of home-treated cases is a serious matter from an educational
point of view and a frequently-used argument against the
home treatment of scarlet fever. There are many parents who are
both able and willing to provide the necessary facilities for home
isolation and treatment, but they naturally hesitate and decline
to make such provision when they are told that it entails the loss
of six weeks education for all school children in the house.
The Efficacy of School Exclusion.
Since 1st January, 1934, Leyton school contacts have been
excluded for only one week, irrespective of whether the patient
has been isolated in hospital or at home; whereas previously school
contacts of home-treated cases were excluded for six weeks.
Three years have now elapsed since the modified procedure
was adopted, and Table B shows a statistical comparative analysis
of the incidence of scarlet fever among school contacts during
the two-year period before and the three-year period since the
modification of the regulations.