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The diminution in the number of cases notified in August, especially at the school ages, is
clearly shown in diagram XXII., which is based upon the notification figures of the seven years 1892-98.
This diagram shows the facts for diphtheria only, but the above tables show that the diminution in
the number of cases of scarlet fever in August is also conspicuous and principally occurs at the school
ages.
The Administration Necessary for the Limitation of the Spread of Infectious Disease by
Schools.
The very considerable evidence which has been adduced in recent years of the spread of
infectious disease by school attendance, the frequency with which London medical officers of
health have found that outbreaks of measles, diphtheria, and scarlet-fever have been caused in
this manner, the abundant reasons for the opinion that infectious disease in London is largely
increased and maintained by school attendance, make it necessary to consider the sufficiency of the
measures which can be taken for the limitation of disease caused in this way.
The code of regulations for day schools issued by the Education Department provides—
Article 88—The managers must at once comply with any notice of the sanitary authority
of the district in which the school is situated, or any two members thereof acting on the advice of
the medical officer of health, requiring them for a specified time, with a view to preventing the
spread of disease, or any danger to health likely to arise from the condition of the school, either to
close the school or to exclude any scholar from attendance, but after complying they may appeal
to the Department if they consider the notice to be unreasonable.
The Public Health (London) Act, section 55 (4) provides that where a medical officer of
health receives a certificate from a medical practitioner that a child is suffering from an infectious
disease within the meaning of that section, he shall, within twelve hours, send a copy of such
certificate to the head teacher of the school attended by the patient, or by any child who is an.
inmate of the same house as the patient. The receipt of such copy of certificate does not impose
anv duty on the Elementary School Authority, who are only required to act in accordance with
the provisions of article 88 of the code of the Education Department.
The London School Board has, however, given instructions to its teachers which go far
beyond the requirements of the Education Department. Thus the school teacher is required
to exclude from attendance any child coming from a house in which infectious disease is known to
exist, and this requirement extends not only to those diseases which are subject to the notification