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are only affected by a mild unrecognised type, that any circumstance
that tends to bring large bodies of children in close association
with each other must be attended with considerable risk,
and is presumably responsible for some amount of spread. Mr.
Shirley Murphy, the Medical Officer to the London County
Council, has pointed out in a recent Report that while there has
been, of late, an increase in the death-rate from diphtheria in the
Metropolis, this increase has been disproportionately great at ages
between 3 and 10, a period which may be taken to represent
broadly that of school attendance. This special liability also dates
from the time when increased activity in enforcing attendance at
elementary schools was brought into play (about 1871) by the
operation of the Elementary Education Act. Dr. Thorne and Mr.
Power have also, prior to Mr. Murphy's Report, demonstrated the
influence that school attendance exercises upon the diffusion of
diphtheria epidemics.
Now the School Board for London compels the attendance of
children at certain ages at the Board Schools, and the responsibility
of any infection which may be thus incurred must rest with that
Board unless and until some measures more efficient than those
which have yet been taken, are adopted. The matter is not an
easy one to settle, and the Medical Officer to the School Board is,
to my knowledge, giving it his best consideration. So far as I can
judge, there is only one way in which the difficulty can be faced.
Obviously no impediment should be put in the way of securing the
enormous benefits of compulsory education, the only question is
as to how the risks attendant upon such Board School education
may best be met. Now at present we notify to the teachers all
cases of infectious illness in houses from which children attend
school, and very explicit directions are given to the head-teachers,
by the London School Board, to enable them to detect and deal
with cases of infectious disease in any scholar who may present
himself at the school; but these measures do not apply to those
cases of mild unrecognised cases of diphtheria which are so