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The classroom was thoroughly disinfected on March 27th, but in spite of this two further cases
occurred.
The fourth case, A. B., was absent from April 2nd to 6th. The inflammation started under the
left eye where the skin was swollen and red. The head teacher sent her to a local practitioner who
diagnosed an infectious process. Seen on April 8th she was an undersized and ill-nourished child. There
was a small punctured point, covered with a scab, below the left eye but no longer any inflammation.
The fifth case, M. W., ceased attending on April 3rd. The inflammation commenced under the right
eye and spread across the nose to the face. Seen on April 8th with "St. Anthony's fire" she had erysipelatous
inflammation of the skin of the face including nose and cheeks, which were red and swollen
with a definite margin, and here and there little vesicles especially about a linear scratch under the right
eye where the inflammation is said to have started. She was well developed and nourished, and at the
time when seen was extremely ill and suffering with bronchitis. She had sat immediately in front of
A. B., who had become ill the previous day.
The spread of erysipelas through a class in this manner is a rarity that may almost be described
as unique. The origin of the inflammation in at least three cases from a scratch below the eye, and in
the same position in the other two is suggestive of factitious production, but the fact that the cases did
not originate at once but at intervals, and that none of the children were particular friends is against
this. Two of the children were exceptionally sensible, intelligent and truthful, and denied all but the
possibility of an unnoticed and accidental scratch. The classroom was at the top of the building and
had been used as an art room, having shadow curtains which could be rolled upwards, out of deep and
dusty troughs, which it was impossible to clean, and which were therefore removed.
INFECTIOUS DISEASES.
Notifiable diseases.—During the past year, London has suffered from a more than usually
severe prevalence of scarlet fever and diphtheria, the former especially showing a marked increase as
compared with the previous year. For the last five years, the number of scarlet fever cases has been
steadily rising, and the figures for this year justify the opinion expressed in last year's annual report,
that the crest of the upward wave of epidemic prevalence has been reached. There is reason to
think that the incidence of this disease will now begin to diminish. Scarlet fever and diphtheria are
the only notifiable infectious diseases which to any material extent affect school children and special
reference is made to these diseases on pages 47-54.
Non Notifiable diseases.—The principal non-notifiable diseases which affect school children
are measles, mumps, whooping cough, chicken pox, ringworm, ophthalmia or blight, and scabies.
With the exception of measles and whooping cough, these diseases although seriously affecting attendance
at school, are not dangerous to life. Among children's diseases, measles claims the heaviest deathroll,
due largely to ignorance on the part of parents.
Charts.—The actual rise and fall of scarlet fever (Diagrams D, F) and diphtheria (Diagrams
E, G) each week, and the percentage of deviation above or below the weekly mean, are shown in
the diagrams. All cases notified by the school teachers are allocated in the various weeks in which
they occur; accurate comparison between the curve representing all persons and that representing
elementary school children is thus ensured.
The measles chart (H) represents the comparative prevalence of the disease during the past
three years.