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Report of the Medical Officer (Education).
135
It is fortunate that there was no further spread. Although, judging from records of the
vaccinated condition of the community, the amount of immunity to smallpox in the population is
decreasing it appears to be sufficient yet to hinder an extensive epidemic. So long as the cases are
not too numerous to be rapidly shut off by immune persons comparative safety exists. It is at present
impossible to say whether it is cheaper to the community to deal with smallpox, as was done in the
present epidemic, or to insist on abundant immunity through vaccination. The present method means
an amount of watching, visiting, and examining of individuals which may be expected to get more
frequent and greater as time goes on and the community becomes less immune.
The school nurses and doctors who had not been vaccinated for seven years, were generally
re-vaccinated, the results of the operation showing that they mostly enjoyed a fair amount of protection.
In several schools arrangements were made through the managers for the vaccination by public
officials of those children whose parents wished it. The first step was a circular signed by the head
teacher issued to the parents or guardians of the children as follows :
"I am advised by the Medical Officer (Education) that, as there is risk of your child having come
in contact with smallpox infection, it is desirable to protect it as far as possible against the severity of
the disease. If the child has not been vaccinated at all, this should be done to-day or to-morrow. If
the child has not been vaccinated during the past seven years it would be better to have it re-vaccinated.
Vaccination can be done to-day or to-morrow at the school for your child, if you will sign your
name at the bottom as agreeing to this, and return the paper to me."
A considerable amount of vaccination was thus indirectly brought about in the anected districts.
At Drury-lane Day Industrial School three boys were known in June to have "bad eyes," there
was nothing suspicious about any of them, but on June 12th another boy was noticed with slight conjunctivitis.
On July 17th all the boys were examined, and two of the first three noted as still having
" bad eyes." They then went to camp at Ramsgate. On August 14th, when examined, all appeared
well. After returning from Ramsgate eye troubles began and by the end of the month 21 cases of acute
catarrhal conjunctivitis, not of a very virulent type, had occurred. A week later 41 cases were being
treated, 16 with prescriptions obtained at hospital, and 25 with perchloride of mercury solution, one
three-thousandth dilution. Either a fresh source of infection had occurred or more probably some of
the previous cases relapsed and became infective. The Koch-Weeks bacillus was found in discharges.
It was necessary to treat the disease energetically, and a nurse and doctor were detailed for the purpose.
At one time fifty cases were affected. All recovered without ultimate bad result, but it was the end of
the year before all were free. Possibly some were kept suspect long after danger was over, and some
others were still suspicious owing to the energetic treatment being continued. Instructions were issued
to all concerned in school pointing out that this variety of ophthalmia is very contagious and difficult
to distinguish from simple conjunctivitis, except by its infectivity, also that it is very obstinate and
prone to recur in its later stages.
It is spread from person to person either directly through the discharges from eyes, nose or throat,
or indirectly through the agency of some article which has come in contact with a sufferer, such as clothing,
handkerchiefs, or towels, schoolbooks, pencils, rulers, possibly doorhandles, and so on. The strictest
precautions must be carried out in details, to limit the spread from affected persons. The most insignificant
error may serve to break down the quarantine and prolong the school invasion for months.
The teacher must be able to recognise both early and late stages of the disease, and conscientiously
carry out all precautions in every detail. Each morning, first thing, the children must file past the
teacher, who must isolate a child with the slightest abnormality in the appearance of the eyes. Any
child once isolated should remain "affected" until the doctor definitely certifies him free. The infected
children must enter school separately, and must be kept out of all contact with the healthy at all
times. They must be separated at meals, and arranged so that healthy and affected are seated with
their backs to each other. The infected ones enter last and leave first. All utensils from the affected
children must be placed in a boiling solution of strong soda. No serviettes or tablecloths are to be
allowed at meals, and seats and tables are to be wiped over with a cloth soaked in a strong disinfectant
solution. Affected children must not enter any kitchen or service room, or in any way handle food,
clothing, books or school apparatus. Separate washing and lavatory accommodation must be most
strictly enforced. The towels used by patients must not be allowed to dry, but immediately
dropped into disinfecting solution. No paper is to be allowed loose in any of the W.C.'s.
These precautions were advised at Drury-lane, and, moreover, the affected children had their
playtime separately and were not allowed to handle any playthings used by the others; no
affected child was allowed to enter the classrooms or to touch any school apparatus or seat belonging
to the healthy children; in the classroom used for the affected children all objects used were placed
in a tub of disinfectant or else destroyed by burning; the desks and seats were daily wiped over by a
cloth damp with strong disinfectant and the children did this themselves; all manual instruction was
" out of bounds " for the affected; the teacher who had had anything to do with the affected children
or their utensils, had to wash the hands before undertaking other duty; the children were treated in
their classroom. The doctor saw them in the morning, and the nurse treated them night and morning.
The children were instructed how to avoid the spread of infection when at home and were not allowed
to loiter about the school.
Defectives.
Catarrhal
Conjunctivitis.
The medical examinations of children with a view to admission to special schools still increase
in number. These examinations and the examinations of cases presenting special difficulty which have
taken place for the past ten years constitute a kind of" school clinic for more detailed examination," as
Results of
examinations