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In pursuit of what I conceived to be my duty, under these circumstances I visited the school, and
asked leave of the head teacher to examine the children, with a view to the detection of any mild and
unsuspected cases of scarlet fever. The examination consisted solely of viewing the face, ears, throat
and hands of each child. Among the 30 children I examined, I discovered two with unhealthy throats,
and one with a discharge from the ear, who I requested might be excluded from school as possible
conveyers of infection.
The teacher now requested me to desist, saying she thought she had better consult the School
Board before submitting any further children for examination. Consequently, no more children were
examined, but whether as a result of the action taken or not, no more cases occurred in connection with
this school.
The outcome of the teacher's communicating with the Board was a letter to your vestry, severely
censuring my action in examining the school children, and stating that the Board could not allow mo
or any other medical officer of health to examine children in their schools.
I reported the above facts to your vestry at the time, and, on your order, the following reply was
sent to the School Board:—"In reply to your letter of 15th July, the vestry desire me to enclose a copy
of a report received from their medical officer, and say that, in view of what is contained therein, they
consider the action of their medical officer was taken in the interests of the public health, and with due
consideration to the orders under which he acts. They cons;der the examination of children in the
board schools, as occasion arises, an important and indispensable means of arresting infection, and under
present conditions, and until the School Board is in a position to undertake it, it would appear that the
responsibility for such examinations must fall on medical officers of health. They gladly recognize the
great services of the School Board to elementary education, and their willingness hitherto to co-operate
with sanitary authorities in all measures for preventing infectious diseases, and they hope the Board will
reconsider their decision and again, as in the past, give all facilities to medical officers of health in
investigating and putting a stop to infectious diseases."
It is interesting in view of the School Board's letters to record the fact that this school was closed
in 1894 on the recommendation of Dr. Priestley, my locum tenens, on acoount of an outbreak of scarlet
fever. At that time, on different occasions, Dr. Priestley and I examined children in the school and
detected cases of scarlet fever in actual attendance. On the reassembling of the school I examined the
whole of the children to see that they were free of infection. No objection was then taken to such examinations
being made, and it is obvious that in the interests of education as well as of health it is desirable
that any unsuspected cases of infectious disease should be detected, and so the necessity of closure of
the school be prevented. If the parents objected, or were likely to object to such examinations, it will
be reasonable for the Board to exercise their undoubted right to refuse them; but my experience convinces
me that nine-tenths of the parents are only too glad for such measures to be taken; I have never
heard of any objection beiug made except by those whose children were detected at school in an infectious
state and consequently prevented from attending, and their objections must surely not be regarded.
I have little doubt that when the School Board comes to seriously study this subject the above considerations
must have due weight with them, and I think there is good reason to hope that they will in
future, as in the past, seek to facilitate the examination of school children by health officers, or perhaps
they may adopt an even better course and appoint certain special medical men to systematically examine
children in schools as is done in New York and other places, for it cannot be denied that schools are
largely concerned in the spread of the infection of many diseases besides scarlet fever.
There were a few cases of scarlet fever at Conway-road School, and 1 visited the school and
examined several cases by request of the teachers as on previous occasions. (Since the School Board
letter I have, of course, abstained from making such examinations.)
Of other matters discussed in the annual reports may be mentioned the occurrence of several
cases of scarlet fever in the married soldiers' quarters at Victoria and Wellington houses, in Westminster.
The medical officer of health of the district comments upon the need for premises belonging
to the Crown being made subject to the provisions of the Public Health Act. The report of the
medical officer of health of Paddington contains an interesting record of the results of inquiry into
the behaviour of scarlet fever in houses in his district. He found that one case occurred in each of
280 houses, two in each of 56, three in each of 21, four in each of 6, and five in each of 2 houses.
As in previous reports, I have shown in diagram VII. the number of cases of scarlet fever appearing
in each weekly notification list in relation to the mean of the year. The summer holiday of the
London School Board schools began in 1897 at noon on Thursday, the 22nd July, or the latter part of
the 29th week, and the schools re-opened on Monday, the 23rd August, or the beginning of the 34th
week. If the number of cases notified in the four weeks, which would be most subject to holiday
influence, be compared with the four preceding and four subsequent weeks, the following results are
obtained—

It will be seen that the decrease in the number of cases notified during the period of holiday
influence and the subsequent increase in the following period is most marked at the school age.
Scarlet fever—Proportion of cases and deaths in hospitals.
It will be seen by reference to diagram VIII. (page 27) that the proportion of cases admitted
to, and deaths occurring in, the hospitals of the Metropolitan Asylums Board during 1897 was greater
than in any previous year.