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that compulsory attendance at school had its beginning, has affected the country as a whole, and has
not only been maintained ever since, but has steadily grown in proportion until the present time.
Examination of the figures supplied by the notification of diphtheria, points in the same direction.
The very striking difference in the age incidence of notified cases when schools are in operation and
when school attendance is suspended for the summer holidays, is in agreement with the hypothesis
that the age incidence of diphtheria mortality has been affected by the increased attendance at school.
Again, this behaviour of the figures supplied by notification is not limited to those of London, but is
shared by the figures of other large towns.
I am satisfied that the full recognition of the effect of compulsory school attendance in this
connection is absolutely necessary if efficient measures are to be adopted for the prevention of diphtheria
caused in this way.
Referring to the steps which may be taken with this object, it is, I think, necessary to
emphasize the fact that the system of notification supplies but a very incomplete record of the total
number of persons actually suffering from the disease; that its principal use is to give indications as to
where inquiry should be made; and that the circumstance that schools contribute largely to the
prevalence of this disease not only justifies but necessitates the medical officer of health having free
access to schools, where school children can be most readily examined, for the prosecution of his
enquiries.
I am led to make these observations because the medical officer of health of a London district
reports that the London School Board has addressed to his authority a letter "severely censuring"
him for examining in school certain children during scarlet fever prevalence among the pupils of the
school, where, in fact, he found children he had grounds for regarding as possibly infective. The Board
stated that they would not allow him " or any other medical officer of health to examine children in
their schools."* This subject urgently needs the attention of the Local Government Board and the
Education Department.
Shirley F. Murphy,
Medical Officer of Health.
* Report of the medical officer of health of Plumstead for the year 1897.