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Report of the Medical Officer (Education).
119
watched, produces apparently no noticeable effect on the prevalence of such diseases as diphtheria or
scarlatina. This, however, is to be expected when the effects of school attendance in respect to these
diseases are fully examined. The enquiry alluded to above as to the causes of infection in each case of
diphtheria notified in the heaviest week of 1909, showed that in only five per cent, could school infection
come into consideration, and that there was not the slightest probability that it could possibly have
had to do with any of the other cases. As regards scarlatinal cases, the Battersea enquiry completely
negatived the theory of school influence. Measles from its nature is more likely to be disseminated by
school attendance than either scarlatina or diphtheria. Unfortunately, the measles record, as will be
shown a little later, is very defective, excepting as regards mortality. It is highly probable too, that in
the future the effect of school attendance on measles among crowded populations will be shown to be less
than is now credited. If the mortality figures of measles, diphtheria and scarlatina be set out as in Fig.
10, which takes the numbers each week in three weekly averages to equalise the varying times of
fatalities in different cases, the holiday influence at Christmas is noticeable in the measles curve, but
wanting in the others, although deaths are proportionately twice as numerous for diphtheria as in
summer, and school influence should be more marked.
In the summer the holiday effect on measles mortality is unmistakable, whilst it is difficult to
notice any effect on the diphtheria or scarlatinal curves which is not fully compensated by t he reduction
in child population. The holiday effect from migration is absent at Christmas. On mortality
the effect of teacher and attendance officer is obviously negligible compared with their effect on
notifications.
The weekly deaths for diphtheria and scarlatina, summed for the decennium 1900-09, are set
out in Fig. 4 in thin lines for diphtheria and thick for scarlatina. Holiday periods are indicated in black
on the chart, and the portions of the curves subject to holiday influence are dotted. The insignificance
of this reduction is such that if the whole effect be ascribed to school attendance, the effects of migration
being neglected, the result of the month's closure affects the annual number of deaths from diphtheria
by 7 or 8, and from scarlatina by about 6, that is about 1 per cent, of the yearly mortality. Thus, in
respect of scarlatina and diphtheria the effect of school influence on the diffusion of these diseases
is not great, even if the highest estimate ever put forward be accepted, without discount, but when
discounted in the view of other known factors it becomes vanishingly small.
Finally, to sum the general question, it cannot be too strongly insisted that under the conditions
which have prevailed during the past ten years in London, the role of elementary schools in the diffusion
of outbreaks of scarlet fever or diphtheria is so trivial that they may be neglected as factors compared
with other causes, which hitherto have come in for little observation and but slight attempts at control.
This long discussion of almost an academic nature, would have been out of place save for its bearing on
any further expenditure through school efforts being thereby shown to be uneconomical, compared with
expenditure in other directions for the repression of infectious disease.
Taking scarlatina, diphtheria and measles as the chief infectious diseases of school life, it is found
that they continue to vary apparently without reference to school attendance or school treatment.

Scarlet fever remains practically on a level with last year's record, and is generally on the downward
grade. The type, too, of the disease is exceedingly mild. Diphtheria on the other hand, continues to
vary about a level, and this year is considerably above the last. The high incidence of measles is fully
discussed later. Charts are given showing the weekly notifications of these diseases, and also the weekly