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Report of the Medical Officer (Education). 175
Diagrams X, Y, Z and AA, illustrating the deviation of scarlet fever and diphtheria above
and below the weekly mean, and tracing by means of curves the course of these diseases for the past
year will be found at the end of this chapter. The measles diagram (BB) shows the rise and fall of
the disease for the past five vears.

Schools
under Special
Observation.
Although as a general policy in the prevention of infection school closure has been practically
abandoned, it has been considered desirable on certain occasions, where other and more detailed
methods have been attempted but have failed to elucidate the sources of infection, or where the coexistence
of two diseases has complicated investigations, temporarilv to close departments or classrooms.
School
Closure.

In addition to the closures specified in the above table one infants' department was closed one
day for disinfection.
The policy of excluding for varying periods unprotected children from infant classes and
departments in which measles has occurred has been rigorously carried out.
Exclusion of
Unprotected
Children
(Measles).

On certain occasions it has been considered desirable during the prevalence of measles or
whooping cough to exclude temporarily all children under the age of five years, and this procedure
has been adopted at 1(5 schools (9 by order of the local sanitary authority) on account of measles
and from two schools (by order of the local sanitary authority) on account of whooping cough.
Exclusion of
all Children
under Five.
The schools have been remarkably free from this disease during the year. The number of
notifications from teachers was 1,861, as compared with 2,212 in 1909. In all 81 schools
were under observation; 999 cultures were taken in 17 schools and 35 children excluded as carriers.
The general source of trouble was the occurrence of two or three cases in a department in children
associated together in school. The detection and exclusion of carriers in each instance was successful
in arresting the outbreak. In only one school was more than one visit necessary for this purpose, and
as it illustrates the ineffectiveness of school closure in arresting the spread of diphtheria, the following
details are given: Isolated cases in which the children last attended school on May 27th, June 15th
and 28th, and July 1st, occurred at St. John's School, Greenwich. It became apparent later that the
disease was extending in the district, and on July 9th cultures were taken from 42 infants at the school.
In one of these a growth of Klebs Lee filer bacilli was found, and the child was excluded. No fresh cases
occurred in the department before the end of the term. During the summer holidays, however, the
attention of Dr. Annis, the medical officer of health, was drawn to the fact that the disease continued
to spread, chiefly among children in the girls' department, four of whom were notified during the
holidays on various dates. A visit was, therefore, made on August 22nd, the first day of term, and
cultures taken from 62 girls, amongst whom two carriers were found. Subsequently another girl was
notified whose last attendance at school prior to her illness was August 26th, and two infants who were
last at school on August 25th. On 1st September cultures were taken from 55 infants, of whom one
Diphtheria.
(e) 3 departments closed by order of the local sanitary authority.
(/) 11 classrooms closed by order of the local sanitary authority.