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While it is of coursc natural to conclude that the low prevalence of scarlet fever in 1916, which
was particularly marked in London, may, in some small degree, be explained by the excessive rainfall,
there can be no doubt that in the main this low prevalence is due to the fact that 1916 falls in the
trough of a major wave of prevalence of epidemic sore throat.
It is noteworthy that, in 1916, this low degree of prevalence of scarlet fever was particularly
emphasised by the entire absence of the autumnal rise. It may be argued, assuming that 1916 was a
year in which the susceptible units in the child population were in large degree exhausted, would it not
still be expected on the assumption that fleas play a part in producing scarlet fever, that during the
autumnal prevalence when fleas increased in numbers scarlet fever would also increase ? Mr. Harold
Russell states that "in Northern Europe the human flea takes about 4 weeks in summer and 6 weeks in
winter to pass through its metamorphosis." If then in 1916 the wonted more rapid development of fleas
occurred, how is it that no rise in scarlet fever accompanied it ? The fact is not, in itself, incompatible
with the flea hypothesis—the effect (scarlet fever) is the result of a number of causes, and it must not
be expected that it will vary directly in correspondence with variations in each particular cause. In
1894, 1903, and 1910, years of low prevalence following upon epidemic years, there was similar almost
entire absence of autumnal rise of scarlet fever. (See the charts published in previous Annual Reports).
Measles.
In accordance with the Order of the Local Government Board, dated 27th November, 1915
measles and German measles became compulsorily notifiable diseases on the 1st January, 1916. The
number of cases notified among all persons during 1916 was 47,450, as compared with 19,317 school cases.
The Central Council for District Nursing have issued a comprehensive report containing the
outlines of a scheme for the district nursing of measles, German measles, and whooping cough. The
object of the scheme is "to secure the provision of timely nursing care—in proper relation to medical
advice with a view to saving the lives and preventing permanent injury to the health of young children
attacked by measles and whooping cough." The report reviews the whole subject in the light of
compulsory notification, and the incidental powers of local authorities in respect of medical or nursing
aid. It is pointed out that under Section 12 of the Children Act, 1908, failure to provide medical aid
may be deemed to be "neglect" within the meaning of the Act; and by Section 97 of the Public Health
(London) Act, 1891, any borough council is empowered, with the consent of the Local Government
Board, to "provide or contract with any person to provide a temporary supply of medicine and medical
assistance for the poorer inhabitants of their district." It is hoped that as far as possible sanitary
authorities in London will utilise increasingly their powers in this direction.
With the object of deriving full benefit from compulsory notification in connection with the control
of measles in the schools, an arrangement has been made with Dr. Davies, Medical Officer of Health of
Woolwich, whereby full particulars of all cases of measles notified under the Order are at once
reported to the school medical officer in order that immediate steps may be taken at the school concerned
to limit the spread of infection. As a tentative measure, the principle of class closure for short periods,
instead of merely excluding those children who have not previously suffered from measles, has been
adop'ed in Woolwich with a view to discovering whether by such means greater control over the spread
of measles in schools can be secured. The scheme has only been in operation a short time, and, therefore,
the results cannot as vet be determined.
Whooping
cough.
There was also a decline in the number of cases of whooping cough among school children; only
8,595 cases having been reported, as compared with an average of 10,213 for the previous 3 years.
Whooping cough is still compulsorilv notifiable in the Boroughs of Greenwich, Lambeth, and Holborn.
Ringworm

The number of children who were known to be suffering when lost sight of, owing to removals
and other causes, is not shown in the above table. The increasing proportion of cases treated by X-rays
has risen from 30 per cent, to nearly 56 per cent, of the cured eases. It is gratifying to note that in
spite of military needs in connection with radiography, the percentage of cases of ringworm cured by
X-rays has, if anything, increased during the war.
The number of hair specimens sent up by the school nurses, from time to time, and examined
microscopically during the year was 2,494. Of these, 1,176 were found to contain ringworm fungus,
21 contained favus, and the remainder showed a negative result.
Favus. During 1916, 11 fresh cases of favus were discovered, chiefly in the East End schools,
as compared with 29 in 1915, 38 in 1914, and 49 in 1913. Of the 11 fresh cases, only 2 have been under
X-ray treatment, and the remainder have been treated by ointments and lotions at hospitals, etc.
At the end of the year there were only 7 children known to be suffering from favus.
Industrial Schools, Residential Special Schools, Places of Detention.
The standard of health, so far as infectious illness is concerned, in the Council's residential, special,
and industrial schools, has been very satisfactory. Beyond a number of cases of minor infectious of
contagious ailments, there is nothing of note to record.