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257
school authorities and other interested bodies, this was unsuccessful.
It is, however, with the spread of infectious disease that, as
Medical Officer of Health, I am most concerned, and I am strongly
of opinion that in this connection the continued existence of the
infant departments in the public elementary schools is undesirable.
As already pointed out, the overcrowded conditions prevailing in
most of these schools in the Metropolitan area is an additional
danger, inasmuch as this state of things is bound to predispose
the children to take any infectious disease which may be about.
More especially is this the case in the infants' departments,
crowded as very many of them are, with a highly susceptible
material. Most of the common infections are, as is well known,
readily taken by children under 5 years of age, and for each year
after this period the tendency to become infected in many of these
diseases steadily diminishes.
Furthermore, the danger to the life of the child attacked,
pari passu, is also greatly lessened. A double advantage is in
this way gained in protecting children at the earlier ages from
exposure to infection. It has been shown that the effect of the
closure of schools during the summer holidays exercises a marked
influence in checking notifiable infectious disease (and, I have no
doubt, also non-notifiable). There is no question that many outbreaks
of disease, more especially measles and whooping cough,
have had their origin in infant schools, and many deaths have
resulted therefrom as well as a very great increase of permanent
ill-health. Measles and whooping cough have been shown to have
an increased incidence of mortality in the first two years of life,
accountable probably to increased opportunity of infection due to
density of population. This does not, however, account for the
relatively increased mortality at ages 3 to 5 as regards these
two diseases, which is also evident in the case of diphtheria,
and that this increase is the result of school aggregation is, in
my opinion, the most probable explanation. To take a special
example, the experience of Berlin in this respect as regards diphtheria
has been shown to be the same as that of London, but
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