View report page

Supervision
of dietaries.
The close association of the school medical work with the administration of the provision of
Meals Act is shown by the large proportion milk or cod liver oil "meals" bear to the total, as the
choice of these methods of feeding follows almost entirely upon the advice of the school doctor.
In connection with the scheme for the supervision of dietaries served to necessitous and other
children, the systematic examination of milk meals has been continued during the year. The total
number of samples dealt with was 1,087.
The improvement noted in 1919 in the general quality of the supplies has been continued, only
4.9 per cent. of those examined being reported to be unsatisfactory, whereas the corresponding figure
for 1919 was 8.6 per cent., and that for 1918, 31 per cent.
The maximum addition of water found in any one sample during the year was 38 per cent. As
much as 53 per cent. was found in one sample examined during the previous year ; the largest percentage
of fat abstracted was 33, as compared with 40 per cent. reported in 1919.
It is to be noted that during the months of October and November last, all the samples examined
were reported to be satisfactory. The continuance of the improvement in quality is probably attributable
to the knowledge that an analytical control is kept upon all deliveries.
Periodical examinations of samples of meals other than milk meals have been made as in former
years. In a number of cases the result has shown the meal to be below the recognised standard in
nourishing or heating constituents, and steps have been taken to remedy the deficiency.
Scarlet fever.
Infectious diseases.
During 1920, 11,860 cases of scarlet fever occurred among children attending the Council's public
elementary and secondary schools, as compared with 22,717 (uncorrected) cases among persons of all
ages (see Diagram, p. 81). On the whole, the type of illness was mild, and a large number of
ambulant cases remained undiscovered until the desquamation stage appeared, and there is no doubt
that a very large number of similar cases were never detected.
During the height of the epidemic it became necessary to augment the staff temporarily by the
appointment of two medical assistants on infectious disease work. The numbers of special enquiries
into scarlet fever necessitating school visits during the year was 681.
A noteworthy feature of the epidemic was the manner in which the disease persisted in certain
districts, whilst other areas were comparatively slightly affected. The districts mainly attacked were
in the East End (Stepney, Poplar, Bethnal Green), the area contiguous to these boroughs across the
water (Bermondsey), and, to a less extent, the extreme western border of the county (Fulham and
Hammersmith), and the extreme north-eastern districts (Stoke Newington and Hackney). There
were evidences, however, during the last few weeks of the year that the disease was becoming more
prevalent in the south-eastern districts (Greenwich and Deptford). Only one school was closed, viz.,
Hotham-road school, Putney (Borough of Wandsworth), during the last two weeks in November, and
in this case the closure was ordered by the local sanitary authority under article 57 of the Board of
Education Code. The adoption of such a drastic measure, entailing as it does dislocation of school work
and loss of education, should not be lightly undertaken. During epidemic periods there is often least
justification for school closure, owing to the ubiquity of agencies of infection. It usually happens,
moreover, that closure of a school on account of infectious illness is carried out when the outbreak has
passed its meridian of intensity, or, in fact, has spent itself.
Diphtheria.
Diphtheria.—During 1920, 5,841 cases of diphtheria were reported as occurring among school
children as compared with 13,804 (uncorrected) among persons of all ages. These figures are the highest
recorded since the establishment of the school medical service, in fact for nearly thirty years.
The number of visits by the Council's medical staff to schools specially involved during the course
of the year was 311. During these investigations large numbers of children in the affected classes were
swabbed with a view to discovering carriers of diphtheria germs. During the year, 5,811 swabs were
taken, and of these 721 showed positive results.
In the majority of instances these "carriers" clear up and are able to return to school within
a month. A small proportion of cases, however, become persistent, and are very resistant to treatment.
The following analysis of 493 cases discovered during 1920, or outstanding at the end of 1919, shows
the periods elapsing between the dates on which children were found to be carrying diphtheria germs
and the dates on which they were free from bacilli, and in a fit condition to return to school.
Period.
Number of cases.
Up to 4 weeks 324
4 to 8 weeks 111
8 to 12 weeks 27
12 to 16 weeks 12
16 to 20 weeks 9
Period.
Number of cases.
20 to 26 weeks 3
6 to 9 months 5
9 to 12 months 1
18 months 1