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The only instances of closure of schools on account of diphtheria mentioned in the annual
reports, other than those already referred to, were those of the Church-street Schools, Lee, in the
Borough of Lewisham, and of a school in Westminster. Concerning the latter, Dr. Allan states
that an outbreak occurred in one of the boarding-houses: "Every master, boy and servant was
examined and the school was closed for fourteen days. No pupil was allowed to return without
a certificate certifying that a bacteriological examination had been made and no infectious
organism found."
l)r. Kerr, medical officer of the London School Board, in referring in his report to the
Board to the outbreak in the Ancona-road Board School in Woolwich and to another at Islewortli,
states that: Following the indications given by such instances, it has been decided to attempt
the prevention of school dissemination of diphtheria." There is 110 subject with which the medical
officer of health is concerned for which this attempt is more needed, and it is indeed one in which,
if efforts are made 011 a systematic and comprehensive scale, there is in every way reasonable
prospect of success. It will require the fullest co-operation of the medical officer of health of the
district with the medical officer of the School Board, involving inquiry in the home as well as in
the school and the unstinted use of the laboratory.
Previous annual reports to the London County Council have contained a diagram showing
the effect of the closing of the school for the summer holiday in reducing the prevalence of
diphtheria in the London population, and especially among the children of school age. Dr. Kerr,
in his annual report to the London School Board, has included a similar diagram showing the
e;xtent of this reduction in 1902 not only in the London children of school age, but among the
children attending the Board schools. I11 this diagram the effects of the closing of the schools in
August are conspicuous ; and, further, from this diagram it would appear that a similar,
although necessarily a less marked, reduction attended the closing of the schools at the Easter,
Coronation and Christmas holidays of that year.*
The summer holiday of the schools of the London School Board began on Thursday, the
24th July, i.e., the latter part of the 30th week, and the schools reopened on Monday, the 25th
August, i.e., the beginning of the 35th week. If the number of cases in the four weeks preceding
and four weeks subsequent to the weeks most subject to holiday influence be compared, the
following results are obtained for the age periods of 0—3, 3—13, and 13 years and upwards. It
will be observed that the decrease in the number of cases notified during the period of holiday
influence is most marked at the school age, while the increase in the subsequent period is confined
to the school age.

The results of bacteriological examination of material from suspected cases of diphtheria
are given in a number of the annual reports. In 12 districts material from over 1,500 cases
was thus examined, and positive results were obtained in 23 per cent, of these cases.
Proportion of cases of diphtheria removed to hispifal.
It will be seen from Diagram XIII. that the proportion of cases of diphtheria admitted
to the hospitals of the Metropolitan Asylums Board was slightly less in 1902 than in the preceding
year.
I11 the reports relating to the following districts the number of cases is stated which followed
the return home of a patient who had been discharged from hospital after attack of diphtheria—
Paddington 10 cases, Finsbury 4 cases, Southwark 8 cases, Bermondsey 3 cases, and Wandsworth
8 cases.
Diphtheria—Age and sex distribution.
The following table shows the cases, deaths, case-rates, death-rates and fatality of
diphtheria at the several ages and for each sex in London during the year 1902. As in preceding
years, the incidence of attack at "all ages" was greater on females than on males, but
the death-rate and fatality were higher among males than among females. In the age-groups
* Dr. Kerr's report contains a similar diagram, showing tlie same effect ot the holidays on the prevalence of scarlet fever.