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discovering the early existence of cases of measles. Pamphlets, prepared by
borough medical officers, regarding diphtheria immunisation schemes also have
been distributed in the schools with the Council's approval, where the local
authorities have adopted schemes for providing for the prevention of diphtheria by
such means.
The constant visits of school doctors and school nurses cannot fail to be of
inestimable help to school teachers, parents and children in the opportunity they
afford for expert advice to be given with regard to infectious disease matters, as
well as other aspects of the general life and health of the school child.
The value of the school as a means of observation and following-up during the
outbreak of smallpox which visited certain parts of London during the year and
in which a number of schools were affected, cannot be too strongly emphasised.
The invasion of London by the mild form of smallpox which has been prevalent
for so many years in the north and midland counties, was the most notable feature
of the incidence of infectious diseases in London during the year. Of a total of 305
known cases of smallpox among persons of all ages in London, 110 occurred among
children attending the Council's schools. Altogether 26 schools were affected, leaving
out of account those schools from which non-suffering contacts only were excluded.
The intensive following-up of absentees from these schools, together with the daily
medical supervision, arrangements for mass vaccinations of children by the public
vaccinators on the school premises, the ascertainment of parental consents in this
connection, the dressing of arms after vaccination and a variety of other precautions
involved a large amount of work, and in this connection it must be placed on record
that the willing co-operation of school teachers and attendance officers was of considerable
assistance to the local medical officers of health and to the school medical
service in their efforts to stem the tide of infection. The fact that the outbreaks
in affected areas were localised was an eloquent testimony to the success of the
measures employed, especially when the fact is taken into consideration that London
public health authorities had little or no first-hand acquaintance with a type of
smallpox which is even more difficult to diagnose than is the better-known virulent
type, and is more apt to be overlooked by reason of its characteristic mildness in
many instances. Although the majority of cases were benign, however, some of
the patients were affected with severe prostration or with profuse and even confluent
rashes, indistinguishable from smallpox major. This fact in itself may give pause
to those who are inclined to disregard the need of resorting to the only known preventive,
viz., vaccination, against an illness which even though non-fatal may be
in some cases painful and revolting during the stage of constitutional invasion and
permanently scarring in its consequences. The facilities for using the school
organisation in connection with vaccination of school children, have, there is little
doubt, been the means of protecting a large number of children whose parents probably
would not have taken the trouble to send them to the public vaccinator.
It will be noted in the table below that the incidence of diphtheria among school
children has remained fairly constant as compared with the previous year, although
scarlet fever showed a definite upward tendency. In fact, it will be noted that
scarlet fever has been gradually rising the last few years, the total number of cases
among school children in 1928 was the highest recorded since 1922, when 8,026
cases were reported following upon the epidemic year of 1921 with its 17,028 cases.
It is, however, satisfactory to note that the type of illness generally has been very
mild, and this fact in itself tends to swell the number of cases by the spread of infection
through ambulant cases. On the other hand, diphtheria has lately shown a
definite tendency towards unusual virulence in certain districts, and it is disquieting
to find that in so many cases, children do not receive the early medical attention
that is so necessary. The earlier diphtheria is diagnosed, the earlier anti-toxin can
be administered and the greater are the chances of mitigating the severity of the