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infection exists are to be excluded from school; these handbooks also contain general
advice on how to deal with individual cases under normal circumstances, and rules
with regard to reporting exclusions from school.
It has been deemed necessary to make these prefatory comments on the
relationship between school attendance and the spread of infectious illness, because
many parents, and in some cases even their medical advisers, have been wont to
blame the school when local outbreaks of diphtheria, scarlet fever, or other illnesses
occur. The fact that closure of school premises as a means of checking the dissemination
of infection has for so many years past been abandoned by most public
health authorities of the larger towns as a result of experience of its futility, and
that the Ministry of Health generally discourages such action in the "Joint Memorandum
on Closure of and Exclusion from School," are sufficient arguments against
the " ostrich " policy of school closure.
Having regard to the increasing amount of supervision now exercised, the
tendency in recent years has bean in the direction of reducing the number of exclusions
owing to contact with infectious illness in the home. A scheme has been in
force for some time past in residential institutions, from which children attend
the Council's schools, and where it is ascertained that proper medical observation
is maintained, relaxation of the rules with regard to the exclusion of children from
school is permitted when cases of scarlet fever or diphtheria occur at the institution.
In other words, where proper vigilance obtains both at the school and in the home,
the exclusion of healthy contacts should be unnecessary. It is hoped that the time
will arrive when similar principles will be able to be extended without undue risk in
certain cases to private families, thus avoiding a very large amount of loss of
attendance at school and interference with the children's education.
It is now generally recognised by those best qualified to judge that the commoner
infections are spread by personal contact, namely by " droplet infection " through
the medium of coughing, talking, sneezing, etc. The responsibility of school
classrooms per se, by the retention and persistence of the materies morbi on the
furniture or in the air of the room, may be regarded as negligible, subject of course
to the proviso that proper air space, ventilation and cleanliness are always needed on
general hygienic grounds alone.
Applications for the disinfection of classrooms and the use of disinfectants in
the school are, therefore, consistently discouraged, save in exceptional circumstances.
A retrospect of 1927 reveals once again that the disease which still causes the
greatest difficulty and anxiety is diphtheria. The persistent prevalence of this
disease in recent years is causing public authorities no little concern. The average
number of cases reported annually as occurring among London County Council
school children during the fourteen years 1906-19 was 2,846. During the eight years,
1920-28, the average number was 5,198. It is true that the latter period contained
the two years when both diphtheria and scarlet fever, especially the latter, assumed
epidemic proportions, but even if these two years were taken out of account, the
average annual number of cases reported was 4,848. It is specially noteworthy,
however, that whilst the incidence of scarlet fever has declined to normal dimensions,
the rate of fall in the prevalence of diphtheria has been much less marked, and during
the past three years the general prevalence has almost equalled that of the epidemic
years of 1920-21. Taking the general population during the fifteen years, 1911-25,
London headed the list of diphtheria attack rates in the populous towns of Great
Britain. It is to be feared that no satisfactory explanation is forthcoming to account
for the preference of diphtheria for London, if such be the case. At the same time,
the fact must not be lost sight of that in London, owing to the large number of
hospitals and the completeness of its medical services, it is probable that greater
facilities exist for bacteriological examination, and that the number of cases which