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the metropolitan medical officers of health. There the whole treatment of diphtheria in regard to
school attendance was discussed, and the following important resolutions passed, as a basis of action—
(i.) " That in the opinion of this Branch it is not possible in the absence of a bacteriological examination
to decide that a child is free from the infection of diphtheria."
and further as regards the school attendance—
(ii.) "In the event of the prevalence of diphtheria in any district any child excluded for sore throat should
not be re-admitted to school without a medical certificate of freedom from infection, based on a bacteriological
examination."
Ultimately the Council passed the following resolution:—
"That the Education Committee be authorised to refuse during the presence of diphtheria in any district
re-admission to school of children excluded on account of diphtheria or sore throat until such children shall
have obtained a medical certificate of freedom from infection, based on a bacteriological examination."
In case of diphtheria becoming prevalent in any district the teachers will therefore be instructed
not to re-admit any child who is absent from sore throat or diphtheria until they receive a certificate of
freedom from diphtheria, based on the results of a bacteriological examination. Such certificate can
be given by a private doctor, or will be given by the medical officer of health, free of cost, and it is
advisable that special arrangements should be made so that specimens or cultures taken from school
children, submitted by doctors or medical officers of health can be examined and reported on, free of
cost, at the Council's present laboratory in connection with this department. It will also be advisable
to gradually prepare an emergency staff to cope with any possible future epidemic outbreak of diphtheria,
by training some of the school nurses, under careful supervision, in the precautions to be taken and the
manner of making culture specimens for bacteriological testing.
The Council approved of an instruction to the teachers—that no child who had been in an infectious
diseases hospital should return to school for at least a fortnight after discharge. Since that rule
was established, the Metropolitan Asylums Board on discharging patients from hospital have furnished
them with instructions that they should not resume attendance for three weeks. A wise precaution,
which, however, appears to give a somewhat longer period than required, and in consequence no suggestion
has been made to alter the fortnight exclusion we require.
A number of other diseases which, although infectious or contagious, are not classed under the
Notification of Diseases Act, require consideration. The chief of these are measles, German measles,
whooping-cough, mumps, and chicken-pox.
Measles and whooping cough are exceedingly fatal diseases to very young children. Mumps is
a nuisance, and excepting for exceedingly rare complications, as it has prevailed in London in my time,
is a very trivial disease, so trivial that the majority of cases are returned to school in a couple of days
or so with the medical assurance that nothing is wrong. As we know this disease at present it scarcely
requires any regulation in regard to attendance, and any attempts to control outbreaks by exclusion
would be rendered futile by the prevalent action of medical men. German measles and chicken-pox
are also trivial, save that small-pox is occasionally seen so modified by vaccination that it is taken for
chicken-pox, a risk which, considering the increasing proportion of unvaccinated children in the
poorer class schools, has to be borne in mind, as such a case might give rise to serious or even fatal
cases of small-pox.
Other communicable diseases such as infectious ophthalmia, trachoma, ringworm, favus, scabies
and various parasitic affections are all of so gross nature that isolation of individuals would always be
advisable, school closure never.
Following on what has been written about measles derived from its close study during the past
three years in the Woolwich district, new rules have been adopted.
As measles does not seem to spread unless between 30 to 40 per cent. of the children have not
previously suffered, and ceases to spread when only 15 to 20 per cent. remain unaffected, it follows
that this disease, under the conditions which hold at present in London, may be neglected in schools
above the infant department. Children attending schools above the infant department if they are known
not to have had the disease, and have been exposed to it, may be incubating it, and therefore should be
excluded till the incubation period is over, otherwise attendance need not be interrupted.
The School Management Code has now been modified in regard to these diseases, and is as
follows:—
"(vi) Children suffering from the following diseases must be excluded from school for the undermentioned
periods:—
" Measles, for at least one month.
" Mumps, for one month.
" Chicken-Pox, for at least two weeks, or until every scab has fallen off the scalp or body.
" Whooping Cough, for as long as the cough continues and not less than five weeks from the commencing
of the whooping.
"(vii) Children coming from houses in which either measles, mumps, chicken-pox, or whooping cough exists
must be dealt with as follows:—
" (a) Children in schools other than infants' schools who have not had the disease and all children in
infants' schools must be excluded.
" (6) Children in schools other than infants' schools who have had the disease need not be excluded.
"(viii) Children living in infected houses and excluded from school under section (vii) (a) must absent themselves
for the undermentioned periods:—
" Measles (i) Children attending other than infants' schools, until the Monday following the expiration
of 14 days from the occurrence of the first case.
(ii) Children attending infants' schools until the Monday following the expiration of 14
days from the occurrence of the last case.