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124
Annual Report of the London County Council, 1911.
district as this, whose population had been carefully noted in relation to age, and to the incidence of
the disease. It would probably show that the control of zymotic disease by many of the measures at
present adopted is largely imaginary and that general conditions which have not yet been determined
are more effective factors on which to direct attack. That for children the opportunities for cleanliness,
for play, for avoidance of fatigue, sufficient living room and sufficient playing room would give
more promise of reducing zymotic death -rates than any further special measures which can be
suggested at present.
Diphtheria
As shown in the table on p. 119, following on a period of quiescence there has been a considerable
increase in diphtheria cases during the latter part of 1911. Dr. A. Newsholme years ago pointed
out that such increase is to be expected during the winter after a hot and dry summer. The 45
schools under special observation were visited 60 times, and tube cultures taken from suspicious cases.
As a result of the 1,305 cultures examined 100 children were excluded as infectious and another 74 as
harbouring germs of a suspicious nature.
Until this year cultures were taken from the throat only, but now the nostrils as well as the fauces
are invariably examined, and in a considerable number of cases bacilli were detected in the nostrils when
missed in the throat. The ears have also been occasionally tested and the work of Dr. Helen Hanson,
referred to later, shows that they may be regarded as occasionally a possible source of danger.
The persistence of diphtheria at Brixton-hill due to a carrier has been noted below, although
as the girl is not yet free the history may have to be completed later.
At Princess-road School diphtheria which had appeared in May, 1911, continued in spite of careful
watching. It recurred in different classrooms of the three departments. There were 3 boys, 2 girls,
and 35 infants sufferers, and 1 girl and 6 infants excluded on bacteriological tests, although only 2 infants
were actually determined as carriers. The effect of school cleansing or disinfection was shown by the
persistence of the ,cases after closure and disinfection of the rooms. The contrast between the day
school and residential school is apparent in the following record.
In the spring and autumn of 1911 outbreaks of scarlatina and diphtheria respectively caused much
anxiety at Brixton-hill Industrial School for Girls. The illnesses, however, were under control throughout.
In the notes and records, the name of one child constantly recurs. The other children come incidentally,
but the illness in the school seems to so centre round this child that she may be taken as an instance
of the tendency to harbour infections which some few individuals present. R. C., aged 11, was removed
to the South-Western Fever Hospital on December 28th, 1910, with scarlatina. Enquiries failed to
detect the source of her infection, as she had been in school for a considerable time, and no new girls
had been admitted for about a month. None of the officials could be connected with scarlatinal cases, and
it was concluded that the infection may have been brought in by some of the Christmas parcels which
the children receive. She was transferred later to the Gore Farm Convalescent Hospital, and returned
to school on March 27th. She appeared in good health, save for a finger which was bandaged, and
from which a sequestrum of bone was subsequently removed. After a week of quarantine she was
returned to her dormitory, where 27 other children slept. Here, after three months of absence, she
was made much of by her companions, of whom 12 were later notified with fever. On the evening of
April 5th one child showed scarlatina. It was feared that others might be already infected and examination
led to another girl being isolated the same night. During the next ten days 13 children were notified
to have scarlet fever, most probably infected by R. C. Eight others were isolated as suspicious. Three
further cases occurred on April 21st, and one on the 25th, probably infected from the secondary cases.
As soon as suspicion fell on R. C. she was isolated, notified afresh, and removed to hospital. No blame
could be attributed either to the school or hospital authorities for these "return cases" as every
precaution which experience justified had already been taken.
Many of the cases were so mild in nature that in the ordinary population they would have passed
unnoticed. Without the history of exposure to scarlatinal infection accurate diagnosis would have
been impossible. One of those isolated as suspicious was only confirmed by the occurrence of peeling
three weeks later. The constant vigilance and isolation of the suspects brought the outbreak to an
end with the last case on April 25th. By the end of June all the children were back in school, and
R. C. was apparently quite well. But the tale is not yet finished, for on July 28th a girl was isolated
with a sore throat which might have been scarlatinal or diphtheritic, and on the 30th removed to
hospital, where the provisional diagnosis of diphtheria was confirmed next day. "Carrier" cases were
sought for at once. Seven suspicious cases, one of which was R. C., were isolated. Germs of diphtheria
were cultivated from them on July 31st and on August 1st, although otherwise they appeared in good
health. By August 4th they were clear except R. C. A few other cases were detected, but rapidly
cleared up. R. C. continued to give positive results, so that she was sent to hospital on August 16th.
Four children in all went to hospital of whom only two presented symptoms of illness, the other two
beinn "carriers." The "carriers" isolated numbered 25. Altogether 273 swabs were examined
in the laboratory. Positive results, as indicated by the Klebs-Loeffier bacillus being present, were
found in 63, doubtful diphtheroid organisms in 28, and the rest were negative as regards diphtheria.
By August 30th all fear of spread of diphtheria was at an end, and the rooms were disinfected. This
small outbreak is a good example of the diffusion of diphtheria, probably from the unsuspected carrier,
R. C. It was controlled by repeated swabbing, and by isolation of the carriers and suspects. Although
the isolation arrangements were severely tested, they were found sufficient. On each child returning
from hospital she was isolated until three successive cultures taken on separate days, were found negative.
The child was then bathed, the nose, throat and ears, as far as possible cleansed, and fresh clothing
given before taking her school place.
R. C. and another child returned from hospital on November 2nd. They were placed in
isolation, and cultures from the throat found to be negative. As R.C. appeared to have been the source