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58
hospital, or the beginning of his isolation at home; if there are any suspicious
signs the child is excluded further until pronounced by a medical
practitioner to be free from infection. Infant contacts of measles who
have not had the disease are excluded for 14 days from the appearance
of the rash in the last case in the house; other contacts are allowed to
attend school. Infant contacts of whooping cough who have not had
the disease are excluded for 21 days from the onset of the disease in the
last case in the house. It is not now the practice to exclude for any
time contacts of those suffering from a number of infections, e.g., german
measles, mumps or chicken pox.
Disinfection.
The surroundings of the infectious person may be contaminated
the extent to which this will take place depending very largely on the way
in which the organisms leave the body of the patient. In most of the
infections, the organisms leave the naso-pharynx, passing out to the
air. Many of the heavier particles will fall immediately and so will infect
the floor coverings, the bed clothes or the patient's clothing and hands.
Some of the smaller particles remain buoyed in the air, being carried long
distances, but ultimately falling on horizontal surfaces such as floors or
shelves, or infecting curtains. The air then probably does not remain
infective for any very long period. Naso-pharyngeal infections might
also be transmitted by the soiling of the patients' hands or fingers,
with the subsequent contamination of articles including furniture, books
or door handles. Hands are also liable to contamination with the
organisms which cause gastro-intestinal complaints originating in the
infected dejecta. The procedure to be followed, then, to effect sterilisation
of the premises and their contents will depend partly on the degree
to which these are liable to contamination. Another factor is the viability
of the organism away from the human host. Some organisms are so very
delicate that it is only with the greatest difficulty that they can be kept
alive away from the human. In the case of the infections due to these organisms
there is little point in carrying out any practice of which the object is
to destroy the organisms. Yet another factor to be taken into account
is the susceptibility to infection of those who might be exposed to infection
in the premises. While a room in which there had been a case of
scarlet fever might not need to receive any special treatment if it is to
be occupied after the child's recovery only by the mother who had nursed
the child throughout his illness, the position would be very different
if it was to be occupied by an expectant mother nearing the time of her
confinement. With the background of these various considerations, rules
of practice have been evolved upon which is based the Council's policy
in regard to the practice of disinfection following the occurrence of a
case of infectious disease. Departure from the practice might be necessary
in special circumstances. As these when required are necessary primarily
on medical grounds, any application for a modification of the general
practice is usually supported by a medical certificate.
The Council decided that except in cases of smallpox and typhoid
fever, and in any exceptional cases approved by the Medical Officer of
Health, where disinfection cannot be carried out in the home, terminal