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that children suffering from mild Diphtheria, or Diphtheria in the
initial stage, may be attending school, and the Head Master or
teachers be unaware that they are suffering from any disease; also
that a considerable time may elapse before the local authority's
suspicion may be raised that school infection is at work, owing to
the lack of information as to the class attended by each case.
In order to meet these points, I suggest:—
1. That during periods of Diphtheria prevalence, the
children attending the public elementary schools should be
periodically examined by a medical man, in order to ascertain
whether any of the scholars are suffering from throat disease
of any kind.
2. That children suffering from throat disease of any
kind should be immediately excluded from school.
3. That on the exclusion of any child from school on
account of throat disease, notice of such exclusion, with the
class and department attended by the child, should be
immediately sent to the Medical Officer of Health for the
district.
If these recommendations were adopted by the London School
Board, there would, I believe, be a considerable reduction in the
amount of Diphtheria amongst the scholars under their control
Enteric Fever.—This disease was less prevalent than during
the preceding year; for while 256 cases were notified during 1895,
only 189 were brought to my knowledge during 1896, with 36 deaths
from this cause. The attack rate for the whole is .92 per 1,000, and
the mortality .18 per 1,000 persons. The question of the agencies
which are concerned in the spread of enteric fever is of the greatest
importance. For years this disease has been gradually diminishing
in urban districts, and it has been claimed that this diminution is
due to the improvement in the sanitary condition of towns compared
with rural districts. And knowing that this disease spreads only by
means of the excreta of typhoid patients, one can readily understand
how improvement in sanitation will affect its prevalence. But it is
notorious that the desire for improved sanitation is not shared equally
by rural authorities, nor by those responsible for the health of certain
towns on the coast. For some years I have had cases brought to
my notice in Hackney where the disease had undoubtedly been