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146
Annual Report of the London County Council, 1912.
Comparative
incidence.—
Scarlet fever,
diphtheria
and measles.

Scarlet fever.
The accompanying Diagrams A and B compare the weekly notifications of cases of scarlet fever
and diphtheria occurring amongst school children and all other persons during the year 1912.
The year 1912 has not been characterised by any marked increase in the prevalence of scarlet
fever, although numerically the incidence is slightly higher than during the preceding year. Since 1907
when the disease assumed epidemic form, it appears to have been diminishing both in prevalence and
intensity, although this reduction has been most accentuated during the past three years (vide Table
above). Diagram A shows the characteristic autumnal rise, the disease having been comparatively
quiescent during the spring and summer of the year. 458 schools were under observation for scarlet
fever during the year, and 40 of them were visited by school doctors from time to time for special
investigation. It is interesting to note that two schools, rincess Road and Stanhope School, where
diphtheria was prevalent were also under special supervision owing to outbreaks of scarlet fever. In
every case where a school came under special observation, reliance was placed upon the detection and
exclusion of individual children who exhibited scarlatinal symptoms, however slight, in controlling the
spread of infection.
Diphtheria.
The number of cases of diphtheria reported as Occurring among school children during the year
was 2,571, as compared with 2,572 during the preceding 12 months. Altogether 273 elementary schools
have been under observation as having shown evidence of possible school infection, and of these 75
schools were specially visited for the purpose of investigating the sources of infection and carrying
out culture tests in regard to all children presenting any suspicious symptoms. In the course of these
investigations large numbers of children have been examined, and during the year 2,349 cultures were
tested in the laboratory for diphtheria bacilli, of which 250 yielded the true Klebs-Lœffler bacillus,
whilst a further 174 were found to be sufficiently suspicious to warrant exclusion from school. The
majority of the children proved to be carrying germs of diphtheria in the nose or throat do not suffer
the more serious manifestations usually associated with an attack of diphtheria. Many appear quite
well. These "carriers" are excluded from school and reported to the local sanitary authority, with
a view of being followed up. They are not allowed to return to school until it is established by further
bacteriological tests that they are no longer carrying diphtheria germs. In addition to these special
precautions, the teachers have been instructed to exclude all children suffering from sore throat until
certified free from infection upon bacteriological grounds, whenever there exists any suspicion of the
spread of infection.
Investigations similar to those above referred to were also necessary at a secondary school where
one case of diphtheria and a number of " sore throats " were reported in February. Four children
were swabbed and one of them was found to be harbouring diphtheria bacilli. This "carrier" was at
once excluded. No fresh cases occurred until June, when one more isolated case was reported, but
upon enquiry it was found unnecessary to take any further action and no developments arose.
The discovery of "carrier" cases of disease has brought about a situation of much difficulty
in public health administration. In those instances where no apparent symptoms are discernible, it is
not possible to certify the cases as suffering from diphtheria, and thus they are excluded from the scope
of the Public Health (London) Act, 1891. It cannot be definitely asserted that persons harbouring
diphtheria bacilli, without any outward manifestations of the disease, are in every case infectious,
but it is generally held that administrative action should be taken to ensure that healthy persons may