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increasing prevalence of diphtheria to increasing school attendance receives a check in view of the still
increasing attendance, with a steady decrease in notifications of the disease. Coincident with the
attempted control of diphtheria in the schools by exclusion of suspects detected by bacteriological
means, there was a considerable decline in the monthly notifications in London.
On comparing the behaviour of diphtheria in the London school area with its behaviour in other
large adjoining centres of population, it is found that this drop in the numbers of notifications in 1903
occurred only in London and West Ham. In others, such as Croydon or Willesden, no such drop took
place. In West Ham this drop was followed by a considerable rise, but in the London area the low
level attained in 1903 has been maintained. That this is due to the increased hygienic oversight of
the Council in provided schools is almost to be expected. Although, as at West Ham, a slight increase
is noticed in the number of weekly notifications, there is, as was pointed out in the last Annual Report,
in spite of cases detected which would otherwise have escaped notice, an actual decrease in cases from
provided schools with increase among the others. Thus had it not been for the work done in the
provided schools, and this year to some extent also in the non-provided, an increase instead of
decrease would probably have been the case. Further, although more than half the children of
school age are upon the roll of provided schools only one third of the notifications come from these
schools, in spite of the increased vigilance of both teachers and doctors in looking for slight cases.

The Council has now approved of the measures, referred to on page 29, to effect further security
of the schools from infection.
MEASLES.
The deductions drawn from the study of measles during the past three years have been put in
force in the new regulation referred to under school exclusions for infectious diseases.
There has been no extensive outbreak during the past year. Two schools may be noted as a
having contributed somewhat anomalous records.
St. Thomas (Marylebone W.), Boys' department.—It is very unusual to have many cases in a senior
department. Several cases occurred here, and Dr. Stevenson investigated them thoroughly. All the cases
presented the symptoms of measles, and had been so diagnosed by medical men. The first cases were
two brothers towards the end of February, then the first crop of six cases in their class-room, March
7th to 9th. The second crop came on March 19th.
This is a school which escaped the last considerable epidemic in the district four years ago. It
has no poor nor neglected children. Of 53 boys aged 8-12 in the room where the first cases occurred,
only 25 had had measles, there was at least 34 per cent. of the class unprotected when the disease broke
out, and assuming that the 13 boys who still give a negative measles history are unprotected, this
reduces the number to 20 per cent. still unprotected. This exactly agrees with what was deduced in
previous reports from the spread of measles among younger children, namely, that the disease tends to
spread whenever a class has accumulated between 30 and 40 per cent. unprotected, till the proportion
has been reduced to 15 to 20 per cent. unprotected.
Goodrich-road (Dvlwicli).—In December, 1905, there was a very mild epidemic of 170 cases in
the infant department, which has a roll of 420, whilst only one case occurred in the boys', and four in
the girls' department. Dr. Alice Johnson reports that the last outbreak being in 1901, the boys and girls
had been through it, whilst the infants were generally unprotected. Some cases had feverish colds in
November, but these had not been diagnosed as measles by the doctors in attendance. The first case
of measles reported was on December 4th. A few cases in this class constituted the first crop. The
second crop presumably began on December 19th, and showed itself from then on through the holidays,
and exhausted the material, there being only two cases later. This is an example of a case which used
to be quoted as showing the efficacy of school closure—the fact being not that the closure affected
the result, but that the material was nearly exhausted by cases infected previously and becoming ill
during the holiday.
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