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Several references are made to the subject of school influence in the reports of the medical
officers of health.
The medical officer of health of Fulham writes " no special school influence could be traced in
the cases occurring here during the year, as among children attending school there were 99 cases with
23 deaths, and 90 cases with 39 deaths among children not attending school; the incidence of the
disease, taking into account the relative number of the two classes being greater on the latter, and in
only 5 of the cases occurring among those not attending school was the disease apparently contracted
from another child in the same house who had been attending school." The medical officer of health of
Hampstead on the other hand writes " personal infection from communication in schools, and from
returned cases from hospitals, was found to be one cause of the spread of disease." The medical officer
of health of Shoreditch, discussing a special incidence of diphtheria on the Acton ward, states " in several
instances no school was attended, but in many cases the disease first attacked a child who was attending
school, and who became, apparently, the means of introducing the disease in the family." The medical
officer of health of Clapham writes "one fact, however, becomes obvious in looking at the ages of the
sufferers. Very nearly all were of school age, very few indeed were under three years of age, and very
few over 15. I think therefore that schools are responsible for spreading diphtheria from pupil to
pupil to a far greater extent than is generally supposed." The medical officer of health of Putney
states that " of the 69 cases notified, no less than 44 occurred in a comparatively small area bounded by
the High-street and Charlwood-road to the east and west, and Upper Richmond-road and Lower Richmondroad
to the south and north." After discussing the sewer ventilators of this area, and water supply
fittings of the houses, he states " as the result of my inquiries, however, in regard to all the cases
notified, I was compelled to come to the conclusion that, after making allowance for the injurious
results of these sanitary defects the majority of the cases were due to personal infection. I was confident
that there were cases of children suffering from mild diphtheria, in regard to whom no precautions
were taken, and for whom no medical aid was called in. The infection was either spread from one to
another during school hours or while playing together in the streets."
In a few instances the opinion is expressed that diphtheria has been caused by exposure to
drain or sewer air. Thus the medical officer of health of Plumstead writes " as to the causes of the
great prevalence of diphtheria in Plumstead, and the comparative immunity of Woolwich, I can only
repeat what I said last year, that I have found nothing but the manhole ventilators to account for it." The
medical officer of health of Islington comments on the disappearance of diphtheria from among the children
attending the Yerbury-road Board School subsequent to the improvement of the drainage of the school,
and states " the Yerbury-road Board School, from the sewer air theory point of view, holds a unique
position, for undoubtedly it proves, albeit negatively, that sewer air can and does convey the germs of
diphtheria into the interior of our dwellings through defective sanitary appliances." The opinion is
expressed by the medical officer of health of St. George-the-Martyr, Southwark, that " amongst the
existing causes (of diphtheria) are (a) density of population, (6) close aggregation in schools with
insufficient floor space, (c) aggregation in block buildings and on their staircases and court yards,
(d) dampness and cold."
The medical officer of health of Clapham recommends the exclusion from school of children
suffering from any sort of sore throat until the production of a certificate from a medical man
that there is no danger of infection. The Public Health (London) Act, 1891, section 55 (4),
requires every medical officer of health who receives a certificate under this section to send within
twelve hours after such receipt a copy thereof to the head teacher of the school attended by
the patient (if a child) or by any child who is an inmate of the same house as the patient.
The medical officer of health of St. George-the-Martyr, Southwark, having notified his willingness
to supply certificates when premises have been disinfected, found on enquiry at a later period " that
about one half only of those who should have called for the certificate of final disinfection came for it."
A communication to the London School Board on the subject led to that Board replying on the 16th
January, 1894, that the Board had recently decided to insert in the Code of Regulations for the
Guardians of Managers and Teachers, the following paragraph—" In the event of the head teacher not
receiving this certificate, it becomes his duty to send to the officer of the local authority in order that he
may procure it," and it was further stated that " if it should be found that teachers do not get the
certificates the School Management Committee of the Board will further consider the matter."
The medical officer of health of Lewisham states that " all children are excluded from school who
come from a house in which zymotic disease is known to exist. I think that in many cases they are
allowed to return before the house is thoroughly free from infection. I have been asked lately by the
medical officer of health for the School Board to give certificates in all cases where the disinfection of
the house has been completed, certifying that the rest of the children in the house are free from infection,
and can therefore return to school. This I have not at present agreed to, as I consider that such
certificates should be given by the medical man in attendance, and that it [might throw onus on
to sanitary authorities, and possibly in some cases lead to legal proceedings. I think that special provision
should be made in the Public Health Act for this matter, as no child should be allowed to resume
attendance at school till a medical certificate is given that the other children in the house are free from
infection and the house itself has been properly disinfected. The medical officer of health cannot be
expected to examine all the children to see whether they are free from infection, and therefore his
certificate in regard to disinfection of premises might lead to misunderstanding."
The insufficiency of hospital accommodation is mentioned by the medical officer of health of
Kensington, and the medical officer of health of the Strand expresses the opinion that opportunity
should be given for the bacterial examination of suspected cases of diphtheria.
Whooping Cough.
The deaths attributed to whooping cough numbered 2327 in 1893, being slightly less than the
number of deaths from this disease in the preceding year.