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15
safely be admitted to school immediately after removal of the patient
to hospital and disinfection of premises.
A rare occurrence is to find Klebs Lœffler Bacilli in discharge from
the ear. In that case similar precautions are taken as when the
bacillus is found in other parts.
After discharge from hospital, and before return to school, the
throats of children are swabbed to ascertain whether they are, in fact,
free from infection.
Parents are advised to consult their medical advisers in those cases
in which return to school is not permitted to their children.
It has been the custom in Tottenham not to send children suffering
from scarlet fever into hospital as a routine measure.
The great obstacle to the domiciliary treatment of scarlet fever
has been the memorandum of the Board of Education. There it lays
down as a principle that contacts are to be excluded from school for
fourteen days after the disinfection of the premises.
In the Health Department section of this report reference is made
to the use of Dochez' serum. If this anti scarlatinal serum proves its
efficacy, as it gives promise of doing, in the cure and prophylaxis of
scarlet fever, I am of opinion that exclusion of contacts from school need
not be extended over a longer period than, at the most, one week; that
period being the limit of incubation of the disease. It is not claimed
that prophylactic inoculation against scarlet fever with 5 c.c.'s will
protect much beyond fourteen days, but by that time, in the average
case of scarlet fever as we see it to-day, the patient is free from infection,
especially if he had the advantage of adequate serum inoculation. The
position is different, however, in those occasional cases where ear and
nasal discharges accompany or follow the acute attack. So long as these
continue, the contacts are liable, when the protection given by the serum
is exhausted, to contract the malady, and exclusion from school may be
warranted. In the light of present knowledge, exclusion should be
exercised at the discretion of the Medical Officer of Health and no hard
and fast rules insisted on. That is the procedure adopted in this
area, and, so far as has been ascertained, without prejudioe to the
school population.