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120
Annual Report of the London County Council, 1911.

* 2 by order of the local sanitary authority, 1 by order of the school managers,
† 10 by order of the local sanitary authority.
‡ By order of the local sanitary authority.
The policy of excluding for varying periods unprotected children from infants' classes and
departments has been continued. Unprotected children were excluded from 7 departments, and from
955 classrooms. All unprotected children under five years of age were excluded from 449 departments
and those under six years of age in one instance from one department. In addition, all children under
five years old were excluded upon 42 occasions, 35 of which were at the instance of the local authority
as was also the case of all under six. On two occasions by request of the local authority, children under
five years of age were excluded for diseases other than measles, one being for chicken-pox, and one for
whooping cough.
Scarlet
Fever.
The general tendency of scarlatina seems to be diminution in frequency, but zymotics follow
long periods of secular variation, thus diphtheria had become almost unknown when it broke out virulently
in the south-eastern counties in 1857. Holland, which as shown on p. 127 for many years has had
the lowest death rate from this disease, is now suffering severely. Within our own memories influenza
appeared to have become extinct when a recrudescence afflicted humanity in 1890 with all the severity
of a plague. When scarlatina cases now occur in a district, children with slight sore throats are excluded
to a greater extent than would have been thought necessary half a dozen years ago, and accentuating the
so-called holiday effect when the disease is more prevalent. It is not clear that in the interests of the
public health it would be wise, if it were possible to attempt, to utterly stamp out every case. Both
with scarlatina and diphtheria a certain amount of immunity in the population seems useful in preventing
violent outbreaks. This theoretical idea has not, however, been considered in practice, but every
effort has been made to keep the schools free from suspicious cases. The school authorities always act
in co-operation with the local authority, to this end. .
At Winchester-street School, which stands about two hundred yards from the Caledonian and
Pentonville-roads respectively, a prevalence of scarlatina caused special enquiries to be made in the
autumn. There were altogether 132 children excluded from the school, which has an average attendance
of 1,238 in the three departments. Of these exclusions 51 were sufferers, including 15 children
who were excluded through having sore throats or other suspicious symptoms. One infant boy had a
second attack within three months. The area in which these children live is nearly a square, bounded
by York, Offord, Pentonville and Barnsbury-roads as shown in Figure 5. No cases occurred in the boys'
or infants' department during the first four months of the year. In the girls' department there was
an isolated sufferer in January, and a girl excluded as a home contact in March. Notifications, however,
showed the disease scattered about the northern half of the district represented. Twenty-eight houses
and seven schools were affected. The Winchester-street area, comprising the lower left quarter of the
map, became invaded about May. The school invasion was characteristic of this disease. On May 11th
a child living on the extreme north limit of the district was first absent from the infants' department
suffering from scarlet fever, and on the same day three children, two of them sufferers, were notified
from Classrooms A, D, and E of the girls' department. The first case in the house of
the girl in Class A was an adult; the girl in Class E was excluded on account of a baby
taken with scarlatina in the house; whilst for the girl in Class D the origin of the
illness was not traced. Several children were excluded from the three departments on account
of home infection, and during May 22nd to 26th five cases of sufferers occurred, again
with characteristic school distribution. Three were in the boys' department, all in different
classes, one was in the girls' department, and one in the infants' department. During June
there were sixteen cases of exclusions for disease at home, but only two actual sufferers, one in the
infants' department, and one in Class H of the girls' department. A considerable number of