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There-are therefore two classes of children in London attending elementary schools, a smaller
class of more than 200,000 children attending schools subject only to the provisions of the Public
Health Act and the code of the Education Department, and a larger class of more than 500,000
enjoying an additional safeguard in the special regulations of the London School Board. The
reports of medical officers of health show that school teachers are always willing to assist medical
officers of health in any measures that may be necessary for the limitation of the spread oif
infectious disease when the necessity for such measures is brought prominently to their notice,
but that for one or another reason this is not always done. This difficulty could best be met by
the medical officer of health of each London district satisfying himself personally that every school
teacher in his district is familiar with the requirements of the regulations which should guide him
in this matter.
From what has been said it will be seen, moreover, that the requirements which are deemed to
be necessary in School Board schools should be extended to other elementary schools, i.e., the Board
of Education should provide that children in elementary schools other than School Board schools
should be equally protected by regulations not less stringent than those which apply to children in
Board Schools.
While the regulations of the London School Board are well designed to deal with such
cases as are recognised, it must be recollected that the system of notification only
brings to the knowledge of the medical officer of health a proportion of the actual
number of persons who are infectious, and who may convey fatal disease to others. For the
detection of the cases of infectious disease too mild in their character to excite attention, nothing
but medical examination of the children can suffice. I am satisfied that inasmuch as attendance at
school is a considerable cause of spread of infectious disease, the examination of school children
should be undertaken in any school, attendance at which is suspected to be causing prevalence of
disease. It is not, in practice, possible in a short time to examine numerous school children in
their own homes, this examination must therefore in great part be made in the schools where the
children are aggregated.
The next question which has to be considered is by whom should the examination be made.
The answer to this question is found in the article of the code of the Education Department which
authorises the sanitary authority to require the exclusion of particular scholars from attendance
at school, and the closure of schools when they deem that this action is necessary to prevent the
spread of infectious disease. The examination should therefore be made by the medical officer of
health, or some medical man acting on his behalf, and it is obvious that to the extent to which
it is possible for him to exclude from the school children who are themselves sources of infection
the less necessary does it become for him to advise his authority to take the step of requiring the
school as a whole to be closed. The medical officer of health is moreover acquainted with the
behaviour of infectious disease in the neighbourhood of the school, and the knowledge of the
condition of children in the school would be of material value to him in determining what action
is required by his authority to limit the extension of such disease.
It has been suggested that parents would be unwilling for this course to be adopted. My
own opinion is that parents would welcome any step being taken which would tend to protect their
children from infectious disease, and that objection based upon anticipation of the parents'
unwillingness has no substantial foundation.
In a report on diphtheria and elementary schools which I presented to the Council in 1898,
and which is appended to my last annual report, the subject of the medical examination of children
in schools was considered by the Council, and it was resolved that copies of the report be sent to
the Local Government Board, the Education Department, and the School Board for London, and
that the School Board be invited to nominate representatives to confer with representatives of the
Public Health Committee as to the matter of the report. London school children have not yet had
extended to them this protection which they so urgently need.
Seasonal Variation in Age Incidence and Fatality of Infectious Disease.
In previous reports I have pointed out that the returns of notified cases of scarlet-fever and
diphtheria in London afford evidence—
(a) Of a seasonal curve of age distribution of cases.
(b) Of a seasonal curve of fatality (case mortality).