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118
Annual Report of the London County Council, 1911.
In a general enquiry in the Battersea area of south-west London in 1909, and a subsequent investigation
by Dr. Thomas, on the sources of infection in diphtheria cases, it was pointed out that there is
a factor acting exclusively on school children which affects the notification of infectious disease during
the school term—the system of visitation at the homes by the attendance officers whenever a child
is absent, and the prosecution of the parents if satisfactory reasons for absence are not forthcoming.
Possibly no other public service compares in efficiency and universality with this in its action on the
whole population. Parents know that if they have no reasonable excuse, prosecution will follow;
during school term, therefore, there is great pressure upon parents to seek medical advice in order to
satisfy the visitors. This ceases with the holidays, and it is probable that numbers of mild cases are
missed at these times, whereas they are frequently brought to light whilst the school visitors are active.
In many of the 99 cases of diphtheria which Dr. Thomas investigated, it was found that the school attendance
officer's visit preceded any notification, and this last was due to his demands for a doctor's certificate.
The discriminative requirements of the school attendance officer explain the increase in the
immediate notification of scholars as compared with, younger children, without giving any clue as to the
real incidence of disease on these two groups of children. The indirect function of the school attendance
visitor as a sanitary officer, has not hitherto met with acknowledgment, but when it is recognised, several
things appear in a clearer light—the sudden drop in notifications when school ceases, and the no less
sudden increase when the attendance visitor resumes his duties then appear in the relation of cause
and effect. So that there is the double effect of school attendance officer at the home, and of teacher,
Figure 4.—London, 1900-09. Average weekly mortality, scarlatina and diphtheria, shewing absence of
marked holiday effect. (See also Fig. 10.)
nurse and doctor in the school, bringing to light numbers of cases when the schools are open, sufficient
to account for any drop when they are closed, without postulating a school effect which there are no
other facts to support.
Were it not for these considerations, it would be exceedingly uncomfortable to think that the
intricate and costly organisation which has been built up by which all the essential facts of the occurrence
of each infectious case among elementary school children in London are daily registered and