View report page

63
virulent diphtheria organisms capable of conveying infection
to susceptible contacts. Again, among apparently healthy
children there are from 20 to 30 per cent. who are "carriers"
of one or other of the 30 types of organism capable of causing
scarlet fever. If the causative organism of scarlet fever
happens to cause a rash, the patient is notified and dealt
with as a case of scarlet fever. But if the same type of organism
causes a sore throat without a rash (which is much more
common) no official action is taken, although the case is equally
infectious. The prevailing type of scarlet fever is so mild
that the rash may last only a few hours. If the visiting doctor
happens to call while the rash is "out" he will notify the case
as one of scarlet fever. If he does not, the patient will be
treated as a case of "sore throat".
These are facts well known to, and acknowledged by,
epidemiologists throughout the country; nevertheless we
continue to spend valuable time and money in the perpetuation
of routine measures of control which were instituted long before
that knowledge was available. If it be considered to be
necessary, as a measure of control, to isolate a person suffering
from scarlet fever and diphtheria, it should be equally necessary
to isolate all healthy "carriers " of these diseases.
In 1930 I submitted to your Committee a report dealing
with the laborious, expensive and ineffective practice of
terminal disinfection; and, after consideration of that report,
the routine removal of bedding and clothing for steam disinfection
after the commoner infectious diseases was discontinued.
Not only has that change of procedure saved
much waste of time and money, but it has been accompanied
by a fall—instead of, as some were disposed to fear, a rise—
in the incidence of secondary cases per household ; and whereas
in 1930 there were only two other areas in the country prepared
to dispense with routine steam disinfection in dealing with
the commoner infectious diseases, it is now becoming the
common practice.
In 1930, however, your Committee were not prepared to
discontinue the spraying of rooms with liquid disinfectant,
the reason given at that time being that "probably public
opinion would be against such a wholesale change." I have
therefore been obliged to continue, since that time, the carrying
out of a form of ritual which can only give to householders a
false sense of security. It is surprising to find how little is