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129
Report of the County Medical Officer—Education.
The analysis which has been given indicates that some condition closely associated with poverty
determines an earlier incidence of scarlet fever in the poorest area. When, moreover, children attend
elementary schools some condition (presumably the same condition) exerts its influence and determines
an even higher incidence of scarlet fever upon the comparatively unprotected " less poor,"
than upon the partially protected "poorest" children. It is quite possible that one of the factors
operating in the schools is the presence of vermin, and this is true despite the fact that the incidence
of scarlet fever at school ages is appreciably less in schools where the children are badly, than in
those where they are less badly, flea bitten.
Diphtheria.—Diphtheria, like scarlet fever, was also specially prevalent during 1914. During
the year 440 schools were under special observation and 81 schools were visited by assistant medical
officers for the purpose of examining suspected cases. During 1914, 2,712 children were bacteriologically
examined, of whom 457 were found to be harbouring Klebs-Loeffler bacilli, whilst in 260
further cases organisms not definitely distinguishable from the diphtheria bacillus were identified.
Amongst these cases were a certain number of carriers of diphtheria germs, who were away from
school for periods varying from three to upwards of six months, in whom successive bacteriological
examinations produced positive results. Enucleation of the tonsils was advised in these cases and
when this was performed negative results were subsequently obtained, and the children were allowed
to return to school. R. C., the industrial school child referred to from time to time in
previous reports, has been in one of the Metropolitan Asylums Board's Hospitals since June, 1912.
She is still under observation. In spite of use of all the available means of treatment she remains an intermittent
carrier ; although, as frequently happens in such cases, she has herself never suffered from the
disease. During the autumn of 1914 she had an operation for enucleation, but diphtheria germs
were still present in her throat a month after the operation.
Measles.—There has been an increase in the incidence of measles, but with the exception of
the year 1913, the figures were below those of any of the previous eight years. During 1914, 742
schools were under observation on account of this disease, including 741 infants' departments, 52
senior departments and 4 special schools. The number of occasions on which unprotected children
Were excluded from infant classrooms or departments is shown on p 130.
The control of measles still constitutes a very serious problem, and varying methods have been
suggested from time to time by public health authorities, some of whom advocate compulsory notification.
In the metropolitan borough of Paddington measles was made a notifiable disease on 17th
March, 1914.
So far as school notifications are concerned, early and reliable information of the first case in the
department is of supreme importance in the prevention of the spread of infection. This being obtained,
effective control would be possible by excluding from school for a limited period children who have
been exposed to infection and are liable to develop the disease. Failure to control the spread of the
disease in infants' schools is often due to belated information as to the original source. In order to
obtain notification of measles early, that is within as short a period as possible from the date of last attendance
of the primary case, an experimental scheme was devised in 1913, by which it was sought with
the co-operation of attendance officers and head teachers to secure notification of the first case
in a school within a week after the sufferer's last day in attendance. The scheme was fully set out
in my report for the year 1913 and was applied to the electoral areas of Bermondsey, Walworth and
Southwark, W. It has been continued during the past year, in the course of which measles became
somewhat prevalent in the selected districts, and it seems justifiable to assume that, in the absence
of stringent methods, measles would probably have attained greater dimensions in those particular
areas. Furthermore, the districts' selected were thickly populated and the social standard was low,
consequently there is no doubt that the efforts made to check the spread of measles in the schools were
largely neutralised by the close association of the children in their homes and in the streets.
Moreover, in any discussion as to the methods of controlling measles, it must be borne in mind
that, in such highly infectious diseases as measles or smallpox, in proportion to the success of preventive
measures, the numbers of susceptible persons in the community will accumulate, and the greater
the proportion of susceptible material, the more difficult does it become to keep the disease under
control.
Whooping cough.— There was no appreciable variation in the number of cases of whooping
cough reported from the schools in 1914 as compared with the previous year, the figures being 9,977
in 1914 and 9,336 during 1913. Owing to the absence of records prior to 1913 in regard to this
disease it is not possible to obtain a clear conception as to its relative prevalence, although there has
been a noticeable decline in the death rate in recent years. The number of deaths in 1914 from
whooping cough was 918 (uncorrected) as compared with 800 in 1913 and 970 in 1912.
Whooping cough was made compulsorily notifiable in the Metropolitan Borough of Holborn on
28th January, 1914. In the Boroughs of Lambeth and Greenwich the disease has been notifiable
since 1912.
Infectious
disease—
Elementary
schools under
observation.

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