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Report of the Medical Officer (Education).
117
need now carefully to examine under-garments to discover the conditions. Still, the reports are that
there is so much work that the nurses attached to the centres cannot fully cope with it. During the
year 53 parents were fined amounts varying from 2s. to 10s., and costs.

The personal hygiene scheme in girls' secondary schools and kindred institutions has continued
in operation during the past year. The scheme was applied for the first time to one boys' school
during the last term of the year. The inspection is carried out by the two assistants to the superintendent
of nurses, one working in institutions north and the other in institutions south of the Thames. At
the beginning of each term a thorough inspection of each pupil is made and a card containing instructions
for cleansing the hair is given to all unsatisfactory cases and they are excluded from school. At an
interval of a week the excluded cases are re-examined, and if again unsatisfactory, they are excluded for
a second period of one week. In order to deal with obstinate cases, it has been decided that in the case
of a scholarship holder, the scholarship should be withdrawn, and in the case of a fee paying pupil, the
pupil should be permanently excluded from attendance at the institution, provided that at least four
weeks shall have elapsed between the first and last occasions. Few cases are unsatisfactory at the second
visit, and still smaller number at the third, but during the year 13 pupils (girls) were proposed for
permanent exclusion from the institutions owing to unremedied defects in personal hygiene.
Secondary
schools and
kindred institutions—
Verminous
heads.

Infectious Diseases.
The principal zymotic diseases in relation to elementary schools are measles, diphtheria, scarlatina,
and occasionally, out of all proportion to its numerical importance, small-pox.
From year to year in this series of reports, various aspects of these diseases have been dealt with
in relation to school work.
So long ago as 1893, the Medical Officer of Health pointed out that the summer vacation might
afford an indication for ascertaining the influence of school attendance on notifications of infectious
diseases. Each year a table has been published in the Report of the Medical Officer of Health, in which,
by the use of percentages, of one month over the preceding, the effect has been set out so as to be unmistakably
manifest. It varies considerably in its extent from year to year. There is, undoubtedly,
some diminution in the number of notifications of infectious disease occurring during the periods of
infection concurrent with the school vacation. Considering what the popular idea is of schools as
centres of disease, the effect is surprisingly small. But the reduction of notifications by no mean3
postulates reduction of disease through this cessation of school attendance, nor does it prove that
school is a factor of any importance in relation to the zymotic diseases. There are indeed, reasons, as
I showed in a statistical paper in 1896, for regarding school attendance as protecting children from
risks of infection in a similar way to which it protects them from risk of death by accident. The aim
in London, in regard to infection, has been to make the school safer than the street.
The holiday effect is a reduction which appears to amount to 15 or 20 per cent., but it has been
already demonstrated by school enquiries in London, that during the vacation there is a reduction of
15 to 20 per cent, in the child population, and this exodus of children has frequently been noted by
country medical officers of health as being the means of introducing infectious diseases locally. Even
this, however, is masked to some extent by a much more potent factor, for many cases are brought to
knowledge entirely through the efforts of school officials. The notifications of diphtheria and scarlatina
are considerably swollen by cases of sore throat sent home from school, which, as shown later
account for about one-fifth of the cases of scarlatina, and in the case of diphtheria include also the
carriers discovered by the bacteriological results of school investigations.
Zymotic
diseases and
school.