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from whom the swab was first taken to Wandsworth. I communicated
the facts to the Medical Officers of Health of both
districts, and the child sent to Wandsworth was subsequently
notified as Diphtheria (probably mixed infection) and the two
other children at Battersea were later notified as Scarlet Fever,
and gave it to the child in the house they were staying in.
This very well illustrates the difficulties of the Health
Department and the general practitioner, as in not one of the
four cases was any rash to be seen when the doctor was called
in, and was so evanescent that it was not noticed by the parent.
A very important memorandum on the question of infectious
disease and its relation to schools was issued in the
autumn by the Chief Medical Officers of the Local Government
Board and the Board of Education conjointly, laying down
the procedure to be adopted with regard to the exclusion of
individual children, those relating to Scarlet Fever being as
follows:—
(1) As regards each child attacked by the disease:
"(a) When treated in the Isolation Hospital he is
usually detained for about six weeks, and longer if
any mucous discharges continue. After return home,
in view of the occasional protracted infectiousness of
patients with such discharges, and sometimes even
of those without them, a notice should be sent to
the teacher, and a notice should also be given to the
parent to the effect that the patient should not attend
school for two weeks.
"(b) When the patient has been treated at home the
same rules apply exactly, assuming that the patient
and his rooms have been effectively disinfected
after the illness has ended."
(2) As regards children living in infected houses:
"(a) When the patient has been removed to the Isolation
Hospital the teacher and the parents should be
instructed to keep all children living in the same
house away from school for two complete weeks from
the day on which disinfection, subsequent to the
removal of the patient, has taken place; and the
parents of all children in the house, especially the
parents of the patient, should be instructed to keep
these children out of contact with other children for
the same period.
"(b) When the patient is treated at home no other
children from the same house should attend school
while the patient is infectious, nor for two weeks
after the end of his period of isolation."
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