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Miscellaneous Closures.—One Non-provided (Infants') department was closed on account of
Whooping Cough and Chicken Pox.

Method of School Closure.—The practice of school closure has been considerably modified
as a result of the work done in the last few years, in observing the progress of disease in the
schools, and chiefly through the measles enquiry in Woolwich and our experience with the bacteriological
laboratory in the case of diphtheria.
Certain diseases, such as enteric or typhoid fever, erysipelas, and puerperal fever are frequently
the cause of trouble through sanitary inspectors serving a uniform notice for all contagious diseases. In
this notice children from the house where the patient is, are forbidden to attend school. For these
diseases this is unreasonable, and in the case of the last two diseases, an absurd requirement. Children
coming from such houses and not themselves suffering need not have any quarantine imposed.
The diffusion of scarlet fever by school means is probably in great measure not very evident in our
returns. The extent of the diffusion is much less in any particular school than would be expected, and
the precise mode of diffusion and spread of scarlet fever is the next question which must come up for
careful study. At present the infectiousness of such cases before the child vomits or the rash appears
is probably considerably overrated. A child without other symptoms but with the rash just
appearing is possibly not very infectious; where, however, there is any suspicion of scarlet fever any
child who vomits at school should be sent home at once, the room should be cleared of children for
the day ; the ejected matter promptly removed, and strong disinfectants used, as it is unsafe to regard
this material as other than a source of contagion. This rule applies to all grades of schools.
Cases occur frequently where a scholar has been away for a day or two with a disease diagnosed
as cold, sore throat, influenza or some such ailment without scarlatina being suspected ; later the child
is found to be " peeling " in school. Where the child is otherwise well, it appears to be quite non-contagious
to judge from the failure in appearance of subsequent cases, but for the child's own sake it is
always excluded, and scarlatina notified.
The really dangerous "carrier cases" are of the type described first by Dr. Newsholme where
a convalescent from this disease has some suppurative or catarrhal conditions remaining. The commonest
of these conditions being aural or nasal troubles, and apparently some small latent patch of
suppurating surface about the natal sinuses or turbinal bones may keep up a condition of infectiousness
for months. These are the most serious cases in regard to school attendance, and what school diffusion
of this disease occurs is probably chiefly due to convalescents. Beyond the disinfection in the case of
sickness referred to above, general school disinfection for scarlatina must rarely be required.
In the case of diphtheria the same danger of convalescent" carriers " arises and in this case the
carriers can be detected bacteriologically. Our experience is that for practical purposes the detection of
the Klebs Löffler bacillus in the throat, nose or ear of any school child, however well the child itself
may appear, requires the exclusion of the child till it is free from the organism. The converse does
not always hold, but for all practical purposes in school work a positive or negative finding, if
confirmed, may be assumed to be a sufficient, though not absolute, guide in the case of school
attendance. To other organisms than the Klebs Löffler bacillus we do not attach importance. The
neglect of many practitioners has been gross in this matter of diphtheria. Some doctors have certified
children as free from diphtheria on mere inspection, even in some cases where they knew the child had
been excluded a few hours previously. In one district our methods were rendered almost unavailing
by the ignorance or carelessness of the medical men whose certificates we have hitherto felt bound
to accept.
In the interests of the public health it was thought desirable to take the feeling of the medical
officers of health for the various metropolitan boroughs on this question. The suggestion of Dr. Annis
was put forward, namely, that when diphtheria was suspected in a district, cases of sore throat or diphtheria
should not be allowed to return to school until a medical certificate based on a bacteriological
diagnosis had been submitted to the school authorities. Most of the medical officers agreed at once,
but as there were practical difficulties likely to arise, and as many explanations of detail were wanted,
a conference was desirable. The opportunity was offered at a meeting of the Metropolitan Branch
of the Incorporated Society of Medical Officers of Health. This branch includes in its membership all