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modified so that terminal fumigation and stoving of articles be
provided free in the case of open tuberculosis and of scabies.
Exclusion.
At the time of the first visit to the home following receipt of
the notification of infectious disease, particulars are obtained
regarding contacts. In the case of adults in most diseases action
is taken only where the contact is brought into relation with foodstuffs
or into intimate contact with susceptibles. In such circumstances
it is, at times, necessary to advise a period of abstention
from work. If the contacts are working in other districts in
similar circumstances intimation of such cases is given to the local
medical officer of health. Child contacts attending the public
elementary schools may be excluded by the sanitary authority
by Article 57 of the Code of Regulations for Public Elementary
Schools, 1922:— "If the sanitary authority of a district or any
two members thereof acting on the advice of the Medical Officer
of Health require either the closure of a school or the exclusion of
children for a specified time with a view to preventing spread of
disease or danger to health." Exclusion may also be enforced by
action of the Local Education Authority under Article 53 by which
the school medical officer has power to exclude children from
school on the grounds that their exclusion is desirable to prevent
the spread of disease. The Medical Officer of Health, therefore,
can proceed only through the Sanitary Authority or two members
thereof. Under Section 150 of the Public Health Act, 1936, which
corresponds to Section 57 of the Public Health Acts (Amendment)
Act, 1907, he can insist on exclusion. "A person having the
care of children who is or has been suffering from or has been
exposed to infection of a notifiable disease shall not, after receiving
notice from the Medical Officer of Health of the district that the
child is not to be sent to school, permit the child to attend school
until he has obtained from the Medical Officer of Health a certificate,
for which no charge shall be made, that in his opinion the
child may attend school without undue risk of communicating
the disease to others." In practice, not one of these three procedures
is followed. According to the regulations of the Middlesex
Education Committee as to infectious disease, "if a head teacher
receives information from the medical officer of health of a district
that a child is suffering from infectious disease or comes from a
house where such disease exists the child must be excluded from
school according to the instructions given by the medical officer of
health of the district." At the time of the first visit the parents
are advised to exclude the contacts for a time sufficiently long to
exceed somewhat the ordinary incubation period of the disease,
dating from the removal of the child in the case of a hospital
treated patient, and a notice is sent to the head teacher of the
department of the school attended by each contact requesting
that the contact be not admitted until a further intimation is