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88
Diphtheria
and Scarlet
fever.
Particulars of all children excluded or absent from school on account of
infectious illness, and suspected infectious illness are circulated on a prescribed
form by the head teachers to the school medical officer, divisional officers (school
attendance), and borough medical officers of health, and if it appears from the
information supplied that infection of diphtheria or scarlet fever is spreading or
likely to spread amongst the children in the schools, arrangements are made for the
special examination of the children by the school medical staff and in certain cases
for the school nursing staff to undertake the daily surveillance of the children for a
definite period. At the same time the teaching staff is warned of the necessity for
maintaining a strict supervision over the children to detect suspects for special
examination by the medical or nursing staff, or to exclude children who show signs
of the onset of illness. The parents are informed of the reason for exclusion and are
advised to keep the affected children under observation and to seek medical advice
if necessarv.

Scarlet
fever.
There was little difference in the numbers of cases of scarlet fever reported from
the schools during 1930 as compared with the last three or four years. The school
medical staff paid 191 visits to schools where it appeared that infection was likely
to spread and 22,226 children were directly supervised or specially medically
examined in this connection. A few cases of mild type were notified as a result of
these examinations and a number of children were excluded from school on account
of sore throat, etc. The children in six of the affected schools were kept under
special observation by the nursing staff for periods ranging from two to six weeks.
Diphtheria.
It will be noted that only slight variations have occurred in the number of cases
of diphtheria recorded in recent years ; 153 of the schools affected during 1930 were
visited on 214 occasions by the school medical staff; 6,688 swabs were taken from
children and submitted for bacteriological examination in the Council's laboratory at the
County Hall. These cultures were taken (a) at the schools, (b) in the course of routine
medical inspections, (c) from children residing in the children's receiving homes,
residential schools and children's homes. Of these, 823 cultures showed the presence
of micro-organisms indistinguishable morphologically from B. diphtheria}. These
823 positive results related to 595 children, of whom 230 were notified and removed
to hospital.
Tests for virulence were applied to some of the cultures ; 19 were returned as
virulent and 11 as avirulent diphtheria bacilli. The children from whom avirulent
results were returned, were allowed to resume attendance at school.
Diphtheria
"carrier "
clinics.
The arrangements entered into with three voluntary hospitals, viz., London,
St. Mary's, and Guy's, for the establishment of special clinics for the treatment of
diphtheria " carriers," were continued during 1930. As stated in previous annual
reports these are the only units specialising in this subject and some of the borough
medical officers of health have taken advantage of the facilities offered by these
clinics for the treatment of persistent " carriers " under, or over, school age.
During the year 27 school cases attended at the London Hospital unit; 14 of
these were found to be negative on re-swabbing. Operations for tonsillectomy were
performed in 5 of these 14 cases. Of the 13 confirmed positive cases 6 were discharged