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54
and Camberwell with very successful results. Most valuable help was afforded by the teachers in this
connection. Much time and attention was, moreover, given to the question of the best form of bathing
accommodation to be provided in certain specially selected schools.
There are now 25 cleansing stations, and it is hoped that another one will be opened during the
year. At 22 of the stations arrangements have been made for children suffering from scabies to attend
for baths and sterilisation of clothing. In all 566,178 examinations of children were made, and in 33,222
cases the children were found to be verminous, 15,929 children were cleansed by parents, 17,293 were
cleansed at the cleansing stations, and 8,371 children suffering from scabies were also given baths. The
total number of cleansings at the stations was 106,639
Epidemic
diseases.
After the influenza of February.March, 1919, there was comparative freedom from cases of this
disease throughout the year. The scarlatinal group of diseases manifested, as had been anticipated, a
rising wave of prevalence, and the year was a dry one. This wall.known association of scarlet fever,
diphtheria, rheumatic fever, puerperal fever and erysipelas—the diseases of Dr. Longstaff's scarlatinal
group—with low rainfall, was thus once again displayed; there was some corresponding increase,
though not a very large one, in prevalence of fleas. It was further clear that after the long interval
of comparative freedom from excessive prevalence of measles, since 1911, with interruption caused by
the comparatively small prevalence of 1915, a more considerable development of measles was again
due; it became obvious towards the close of 1919 that this phenomenon was actually in course of development.
At the time of writing the prevalence has, it is hoped, passed its maximum. The Order relating
to compulsory notification of measles was rescinded by the Ministry of Health in December, 1919, and
while this action was no doubt justifiable, it became the more necessary that a close watch should be
kept upon measles in the schools, and special measures were approved by the Council having this object
in view.
Last year the question of measles periodicity was approached from quite a new point of view, by
Dr. Brownlee, who gave the result of his inquiries in one of the Medical Research Committee's Reports.
The time seems, therefore, an opportune one for setting out the points of agreement and difference between
earlier investigations and his. Dr. Brownlee states that the statistics of London show "that two or more
epidemics with different periodicities may run concurrently," and, he goes on to say :—"Any but a biological
explanation of these phenomena seems to be untenable and the further facts seem to prove that
the periodicity is infinitely more probably due to such changes as may easily constitute the life cycle
of an infecting organism than to periodic changes in the susceptibility of the host. To explain the
phenomena by the number of susceptible persons present in the population at any one time seems hardly
possible."
This hypothesis is critically examined on pp. 86.92. It must here suffice to note that it is quite
at variance with the views generally accepted, for, as Sir A. Whitelegge said in 1892, it was commonly
believed that "the biennial explosions were regulated as to quality by the prevailing phase of measles;
and as to quantity or extension by the number of persons susceptible,by the meteorological conditions
and by the facilities for infection at school or elsewhere"; again, "the keynote to the epidemiology of
measles is stability of type amid violent fluctuations in quantity"; moreover, as regards the major
waves, "an increased tendency to fatal pneumonia ought to be counted among the consequences and
indications of a severe type of measles." It might, perhaps, be added that the environmental factors—
varying birthrate, movement of population, etc.—which influence so largely the range of the minor
biennial explosions, may exert also notable influence upon the major waves. Considerations of this
kind are more fully referred to later (pp. 90 and 91). All those who have been concerned with preventing
spread of measles agree as to the great importance of these environmental influences. Two instances
in point may, perhaps, here be mentioned. First the successive exacerbations of measles prevalence
noted in 1917.18 at intervals of about a fortnight after the occasions when large numbers of London
children were crowded in underground shelters during air.raids: and, second, the well.known and
much studied effect of school influence ; Dr. Brownlee has nothing to say with regard to this in modern
London, but, even he, in discussing certain of the early London records of measles deaths, observes that
"It is of course possible that the returns from a large children's institution, such as the Foundling Hospital,
might furnish the majority of these deaths." The whole subject is deserving of careful study, for wide
reaching influence upon conclusions with regard to combating the spread of measles is likely to be
exerted as the result of confirmation or otherwise of Dr. Brownlee's hypothesis.
Examination
of
Candidates.
The number of candidates for permanent appointment in the school service, and candidates for
scholarship awards who were medically examined, was 6,493. Special reports were made in regard to
1,565 employees, (a) who were unable to carry out their duties owing to personal illness, or (6) in respect
of whom claims were made for exceptional treatment in regard to sick pay, on the ground that the
illnesses were contracted during the course of school duties. The latter number shows an increase of
303 over the similar figure for the year 1914, the excess probably being attributable to war conditions.
During the year, the question has also been raised as to the re.employment of teachers who had been
certified as suffering from tuberculosis.
Special
Schools.
In all 5,494 examinations were conducted with a view to admission to special schools. Of these
3,447 (1,801 boys and 1,646 girls) were certified as suitable for admission, and the remainder were either
returned to elementary schools or found to be unsuitable for any of the Council's institutions. The
results of the periodical examination in the schools for the mentally and physically defective are shown
on p. 92, and special reports are submitted dealing with nocturnal enuresis in residential schools and
trade instruction in schools for physically defective children. It is also pointed out that cases of paralysis
mostly occur at the age of two years, that the onset of tubercle is generally noticed between the ages
of two and six years and that of heart disease between the ages of four and ten years.