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91
After consultation with the Ministry of Health and the medical officers of health
of the boroughs concerned, it was decided that the home contacts of cases of smallpox
should be allowed to return to school provided that arrangements could be made
for their daily examination in school by the school medical or school nursing staffs
of the Council. By this means the disease could be detected in its early stages and
reports furnished to the borough medical officers, whilst contacts who absented themselves
from school could be brought to the notice of the borough medical officers.
The borough medical officers were thus informed at once of all contacts who might
possibly be developing the disease.
Owing to the amount of time involved in this work healthy contacts were only
allowed to return to those schools which were being kept under daily supervision
on account of the occurrence of cases of smallpox. This " limited " form of the
scheme was applied as required during the summer term in all boroughs (except
Finsbury). During the autumn and winter terms, however, the scheme was extended
to include all contacts in any of the schools (except children living in the borough of
Finsbury) and the Council decided to employ additional nursing staff to carry out
the work. Seven extra nurses commenced work in November.

Lhe number of hours devoted to the work is equivalent to the services of seven
full-time nurses. The borough medical officers of health and their staffs have worked
in close and harmonious co-operation with the school medical and school nursing
services and the arrangements made for the supervision of large numbers of children
in school and for the "following up "of those excluded by the school nurses and of
the absentee home contacts have been attended with conspicuous success.
The manner in which the school nurses have carried out their share of this
important work is worthy of mention. Had it not been for their careful supervision
and perceptiveness, many cases would have passed unnoticed. The excellent
results obtained both in the prevention of infection and loss of school attendance
by these new activities of the school nursing service have clearly demonstrated
the advantages of a system of close supervision as compared with exclusion
from school.
It has, in fact, been shown that the only practical difficulty in extending the
principle of supervision of contacts in school to most other infectious ailments lies
in the large increase in the nursing staff which would thereby be entailed.
Encephalitis
lethargica.
During the year under review, 21 children were admitted to the special unit
at the Northern Hospital, Winchmore Hill, established by the late Metropolitan
Asylums Board for dealing with children between the ages of 3 and 16 years suffering
from the sequelae of encephalitis lethargica. 19 children were discharged during the
year and one died. Detailed reports on this subject were included in the annual
reports for 1925 and 1926.
Reports on encephalitis lethargica, by Dr. G. A. Borthwick, medical superintendent
of the Northern Hospital and Dr. F. L. Golla, director of pathology in the
mental hospitals department, has already been published as a separate document,
No. 2811, price 6d., and may be obtained from the Council's publishers.