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The notifications of school children are taken as the cases notified to the school teachers by the
medical officers of health. There is undoubtedly much leakage, especially due to the failure of many
voluntary (non-provided) schools, owing to want of sufficient acquaintance with the Council's rules.
This is rectifying itself as shown by the percentage of school children to the whole, viz., 30 per cent.,
33 per cent., 37 per cent., and 37 per cent, for these periods respectively. It must, however, be remembered
that with increased prevalence the proportion of children at school ages suffering, compared with sufferers
at all ages, tends to increase. During the year 133 provided and 31 non-provided, 164 schools in all,
were under special observation for diphtheria. Routine inspections of children's throats were necessary
in 45 school outbreaks, 770 cultures were bacteriologically tested and the outbreaks were traced to
carriers, of whom 75 were found. Between March 31st and the end of the year 1,780 cultures were
taken at 55 visits to schools and the Klebs-Loeffler bacillus found in 93 cases. Up to March 31st two boys'
departments were closed, two girls' and two infants' and in addition four classrooms were closed for
short periods, while between March 31st and December 31st four departments were closed, one boys'
one girls' and two infants', and in addition two classrooms in a junior mixed department, and one in
an infants' department. In view of the increasing prevalence of diphtheria it will be necessary to use
all possible resources in dealing with the disease. The Council's regulation by which all sore throats
are notified to the medical officers of health by teachers when diphtheria is prevalent in a district, and the
children refused admittance until a certificate of freedom from infection is produced based upon bacteriological
examination, is likely to be of the utmost value where local arrangements exist for free bacteriological
diagnosis. From the school point of view the greatest danger of spread arises from these
mild undetected cases. The maintenance of expensive isolation hospitals, and the universal provision
and carrying out of disinfection in notified cases alone are no longer to be considered adequate protective
measures. Unless facilities exist for the detection of mild carrier cases preventive measures are largely
wasted. Although in practically every large provincial centre of population in this country such provision
has been made, it is not yet available in many of the London boroughs. Unless the whole of the
local sanitary authorities see their way to making such provisions it is to be feared that London may
suffer more severely than is necessary during the coming positive wave which seems almost inevitable
in the next few years.
Facial Eruptions in Diphtheria Carriers.—Attention has been drawn to the presence
of facial eruptions of herpetic or impetiginous nature in diphtheria contacts. Twice the Klebs-Loeffler
bacillus has been found in such conditions. In one case a boy of five at Hawley-crescent School was
found with sores upon his face. The scab of one of these sores was lifted and a culture taken from the
resulting raw surface. The growth gave vigorous colonies of Klebs Loeffler bacilli which were submitted
to virulence tests at the Lister Institute by Dr. Arkwright, who found that they were fully virulent.
In another case at Elizabeth-street a culture of diphtheria bacilli was obtained from what appeared to
be a single patch of impetigo upon the cheek of a school girl. In both instances there were found diphtheria
bacilli also in the nasal discharges and in the throats.
VISION.
The Vision Testing of School Children.—Full details of this have been given in previous
reports. The children are tested, using both eyes, from a distance of 6 metres. Standard Snellen
Test Types are used, and the teachers record the vision in the attendance registers. All children who do
not attain "V.=!68, or above Standard V.=!62, are put on a list which is forwarded to the Head Office.
These children are reviewed later by the medical officer and green cards of warning or red cards in more
urgent cases are forwarded to the parents. The teacher makes what school arrangements are
possible and the worst cases are very carefully noted and if necessary exhaustively examined with
respect to any need for special training as blind or semi-blind.