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is a mild disease, it is responsible for a good deal of disruption
of education among school children, both among the cases themselves
and among the contacts. In considering measures for
controlling Scarlet Fever one gets the impression that there is a
small reservoir or potential reservoir of infection always present
in the schools and that there is a tendency for the disease to
subside during the holidays and the long summer recess. It is
interesting, looking back through old reports, how often the
schools were closed for Measles, Whooping Cough and even for
Mumps. School closure rarely seems to have been used as a
control measure against Scarlet Fever. One very important
factor in "keeping the pot boiling" is, I am sure, the delay in
excluding cases from the classroom. Whether the modern mother
is so determined not to coddle the child that she disregards the
early minor manifestations of illness, whether they are not so
aware of deviations from wellness, or whether in some cases
because of a desire that the child should not miss school is
a matter for speculation, but it is astonishing how high a proportion
of children are sent to school while in the infective
stage of the disease. I have analysed the interval between the
last attendance in school and the appearance of the rash in 69
cases of Scarlet Fever among the school children during the
year under review. Of the 69 cases: —
16 were not in school for 5 days or more before appearance
of rash;
4 were not in school for 4 days or more before appearance
of rash;
12 were not in school for 3 days or more before appearance
of rash;
*23 were not in school for 2 days or more before appearance
of rash;
12 attended school on the day the rash came out;
1 attended school for a further day after appearance of the
rash;
1 attended school for a further 2 days after appearance of the
rash.
* This seems to be the commonest time for the initial malaise
to have been observed.
It is the large group of 12 who were in school on the day the
rash appeared that one suspects is responsible for "keeping the
pot boiling." When it is remembered that the rash in Scarlet Fever
appears on the second day of the disease, it is clear that these 12
children had opportunities of spreading the infection for two days.
In fairness to parents one must add the obvious excuse that if parents
were to keep a child at home every time he looked a bit off
colour there would be a great risk of unnecessary absences.
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