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36
Diphtheria and Elementary Schools.
In connection with the question of the reduction in the prevalence of the disease
among persons of school age during the summer holiday when the schools are closed it has
been thought well to include, as in previous reports, the following table. The summer holiday
of the schools of the London County Council began on Thursday, the 25th July, i.e., the
latter part of the 30th week, and the schools re-opened on Monday, the 26th August, i.e., at
the beginning of the 35th week. If the number of cases in the four weeks preceding and the
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.

Prevalence of diphtheria among the scholars of particular schools are recorded by the medical
officers of health of Kensington (Gloucester-grove School), Fulham (Townmead-road, Hugonroad
and Peterborough Schools), Chelsea (St. George's Home), Stoke Newington (St. Mary's School,
Barn-street, and Oldfield-road School), W andsworth (Oldridge-road, Smallwood-road, Tooting Graveney
and Roehampton Schools), Camberwell (a North Camberwell school), Deptford (Clifton-road and Clydestreet
Schools), Greenwich (St. Paul's School, Randel-place and Blackheath-road), Lewisham (St.
Philip's School, Sydenham, and Lewisham-bridge Schools), and Woolwich (Bostall-lane School).
In some instances classrooms or school departments have been closed on account of
diphtheria prevalence among the scholars, and in other instances particular children have been excluded
from school.
In July of 1906 the Council authorised the Education Committee 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. The ability to control the spread of diphtheria in schools by the
exclusion of particular scholars is referred to in the report of the medical officer of health of Greenwich.
He writes:—
An outbreak which occurred during the year in connection with one of the schools in this district was only
checked by and when this method was rigidly enforced. Occasional notifications of cases of diphtheria, in connection
with the children attending this school, particularly the infants' department, also in the families from which
children came to the school, although the actual scholar was not a patient, had been received. I called, and had a
conversation with the head teacher, seeing the children thus in attendance, who all appeared well; there were,
however, a large number of absentees, many being reported ill with measles; I arranged with the head teacher for all
suspicious children actually attending school to have their throats examined bacteriologically, with the result that,
out of 47 children examined, a positive result was given in eight cases. All these children were excluded from
school, a circular letter being sent to the parents in each case, recommending that medical advice should be obtained,
and it was arranged with the head teacher that no children who were absent from school on the day of the examination
should be re-admitted until they produced a certificate to the effect that bacteriological examination of the
throat had given a negative result, and from this time the cases of diphtheria in this school ceased.
The medical officer of health of Fulham also writes:
Diphtheria was again most prevalent in Sands End Ward, particularly during the last four months of the year,
when 130 cases were reported in that district. There was a special incidence among children attending three of the
schools in the ward, viz., Townmead-road, Peterborough and Hugon-road. The notifications were swollen by the
"carrier cases,'' i.e., cases in which the diphtheria bacillus was found though the children showed no signs of illness
which were detected in these schools consequent upon the bacteriological examination of the throats of the children
in the classes in which cases occurred.
In Townmead-road School, five children harbouring the bacillus were found in one of the infants' classes, three
in one of the girls' classes and one in each of three other infant classes. In Peterborough School eight cases were
found in the boys' department, four classes being affected, and six in the infants' department, distributed among three
classes. In Hugon-road School three "carriers" were found in the girls' department and two in the infants,' At
Townmead and Hugon-road Schools the exclusion of the bacteriological cases was successful in checking the extension
of the disease, and this was also the case in the boys' department of Peterborough School, but in the infants' department
of that school cases of clinical diphtheria continued to be reported until the school was closed for the Christmas
holidays, and there have been no cases since it was re-opened.
The medical officer of health of Lewisham writes : "The system of excluding carrier cases has
been tried, and but for our insistence on closing the class-rooms of certain schools, serious results might