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one such patient can present enormous problems to the Authority, and can cause grave anxiety to the
parents and deep heart searching of the public conscience.
Scabies
The organism causing scabies is a minute parasitic mite called Acarus Scabiei. The fertilized
female burrows into the upper layers of the skin and deposits eggs in the small tunnel which she
excavates. These burrows can often be seen as small sinuous lines in the skin, ¼ to ½ inch in length.
Sometimes the burrow has a small vesicle or papule superimposed on it disguising the underlying
lesion, or the infestation may show as a generalised rash over parts of the body. The patient becomes
aware of the condition by the intense itching which is more pronounced after getting warm in bed.
To relieve the irritation, the patient resorts to scratching which can damage the skin further and cause
secondary infection and subsequent pustulation.
The scabies mite chiefly invades the skin of the webs of the fingers, front of the wrists, elbows,
arm pits, abdomen, buttocks, lower legs, ankles, and webs of toes. It is spread by direct contact of
one person with another and like all infectious disease is no respecter of persons. After infection,
itching may not be apparent for 2-3 weeks and this delay often makes contact tracing difficult.
It is usually a family infection and all members of the family should be treated at the same time.
There has been a significant rise in the number of children reported to be infested with scabies
during the year. 49 such cases were diagnosed during 1972 and 39 visits to 29 schools were made
to investigate contacts of these children. After a steady downward trend during the years 1969 to
1971 in Hillingdon, these figures are particularly disappointing in view of the thorough screening of
many hundreds of children in an attempt to eradicate the condition from our schools. This rise in
the number of scabies infestations reported is a national trend and vigorous measures are necessary
to control it.
All notifications of scabies are passed to the Deputy Medical Officer of Health who alerts the
health visitor of the district in which the infestation has arisen and also informs the school health
section whether a clinical investigation is necessary. The health visitor then visits the home to ensure
that the whole family will accept treatment. The names of the children concerned and the schools and
classes at which they attend are obtained. The school health section arranges for a team to investigate
the contacts at the schools or classes to which the known infested children belong. The team consists
of a medical officer in department who has received special instruction and training, a school nurse
who prepares the children for examination and a clinic clerk who prepares letters for the parents and
family doctors for any child found to be so infested. All children take home a stencilled note giving
the reason for the inspection.
Fresh cases of infestation are followed at home by the health visitor to explain the method of
treatment which the family doctor may prescribe and the necessity for the co-operation of the whole
family—adults and children. (Further details are recorded on page 179).
EDUCATION (MILK) ACT 1971
Under the above act and accompanying regulations, free school milk is provided for pupils at
junior departments in maintained schools on the following grounds:
(1) Where a school medical officer certifies that the pupil's health requires that he/she should
be provided with milk at school. This recommendation can be made at any time whilst a
child is in a junior school.
(2) Where a child achieves seven years of age between the end of the summer term and the
following 31st August, then free school milk is provided for such a pupil in a maintained
school until the end of the summer term following the seventh birthday. This would cover
a child's first year only in a junior department.
At the end of 1972, 1,082 pupils were receiving free school milk in junior departments of
maintained schools.
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