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infection is likely to spread the school is visited by one of the assistant medical
officers, who makes the necessary investigations, examines the children, excludes any
suspicious cases and reports, if there is any serious extension of the disease among
the children, the medical officer's inquiries are supplemented by daily visits by the
school nurse. These measures generally succeed in arresting the spread of infection.
The number of schools which were visited by medical officers during the year, and
the number of departmental visits in connection with local outbreaks of scarlet fever
and diphtheria are shown below:—
Diphtheria. Scarlet fever. Total.
Division. No. of No. of No. of No. of No. of No. of No. of No. of No. of
depts. schools children depts. schools children depts. schools children
visited, visited, examined. visited, visited, examined visited. visited, examined.
N.W. 87 51 7,570 27 22 2,116 114 73 9,686
N.E. 36 25 4,038 80 48 9,996 116 73 14,034
S.E. 150 66 15,721 93 56 9,665 243 122 25,386
S.W. 103 51 13,270 61 49 10,389 164 100 23,659
E. 57 30 6,732 50 35 7,512 107 65 14,244
Total 433 223 47,331 311 210 39,678 744 433 87,009
In addition to the inspections for scarlet fever and diphtheria referred to in the
foregoing table, the medical staff also conducted special inquiries at certain schools
owing to the prevalence of miscellaneous infections,e.g., skin ailments, eye diseases, etc.
During the year the Council's public health inspectors carried out 27 special
investigations at schools where the condition of the premises or environment were
alleged to have been responsible for rendering children susceptible to infectious illness.
The services of the school nursing staff were utilised for investigating and giving
advice to teachers during the prevalence of minor infectious ailments and, in this
connection, apart from the work of the nurses in connection with the measles scheme
(see p. 127), 265 schools were visited from time to time (chicken pox, 104 schools;
whoopine coueh, 18; mumps, 129: impetigo and eczema. 11; ophthalmia. 3).
As has been noted on the previous page, 5,634 cases of diphtheria occurred among
children attending the Council's elementary, special and secondary schools during
1926, an increase of 601 cases over the preceding year. In the annual report of 1925
it was shown how the incidence of diphtheria has progressively risen in the last
three quinquennia. It was also pointed out that the inclusion of purely bacteriological
cases in the notification figures may have partially accounted for this increase.
There is, however, no doubt that there has been an intensification of diphtheria
prevalence in the past five years, although fortunately the increased incidence is not
reflected in the mortality figures, as will be noted in the following tabular statement
showing the number of cases of diphtheria and the number of deaths from the disease
among persons of all ages in London during the past three quinquennia;—
Diphtheria.

Various hypotheses have been tentatively suggested by epidemiologists to
account for these periodic outbursts of infectious illness, such as the appearance in
the community of a fresh crop of "unsalted" or susceptible children, a cyclic
exacerbation of virulence on the part of the particular micro-organism concerned,
housing congestion, humidity, etc. In this connection the researches of Professor
Topley on the subject of experimental epidemiology (see Lancet, 7th, 13th, 27th
March, 1926) are of very great value and worthy of close study.