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of desks and their arrangement in these classes. The desks are
long, with seats made to sit six children side by side. At the time
of my visit to the schools the seats were packed, the children
apparently keeping each other up. This arrangement is one which
I have expressed before as being likely to lead to the spread of
disease from child to child; and I repeat, that I consider all infants
should be separated from each other during school life, by seating
them at single desks and seats in the manner practised for adults in
some schools.
The floor space of the two class-rooms in question is, in my
opinion, insufficient. It varies, of course, according to the attendance,
but it works out for Rush more Road class-rooms at about 6 square feet
per child, and at the Tottenham Road class-rooms at about the same
floor space per child. The floor space should not be at any time
much less than 15 square feet per scholar.
The above, I think, will be sufficient to prove that school
influence has been at work in the outbreaks briefly described; but
those who do not believe that school life is an important agent in
the spread of infectious disease, in their investigation of any
particular outbreak endeavour to trace each successive case to a
previous one, and the only data taken are the notifications. If
this cannot be done, school influence is said not to have been
appreciatively operative. The fact is entirely ignored that in every
outbreak there is a large number of unrecognised cases of Diphtheria
occurring amongst the diagnosed cases so mild as to escape the
observation of both parents and teachers, or if noticed are dismissed
with the appellation of "slight sore throat." Such cases have been
proved to possess the power of infecting healthy persons with a
recognisable form of Diphtheria. The presence of such cases may
be demonstrated in almost every outbreak of Diphtheria if enquiry
be only made at the homes or the throats of the children examined.
Wherever Diphtheria exists, there will also exist, in addition,
numerous cases of sore throat. This I have observed several times.