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Note.— In the above table the schools are arranged roughly in order of their proximity to each
other and are grouped within defined areas demarcated or traversed by the three main thoroughfares
indicated viz., Mare-street (Hackney); Kingsland-road (Hackney and Haggerston); Essex-road
(Islington).
It will be seen from the above table that in each group there are one or two schools which are
predominantly affected. These are shown in bold type. The original outbreak made its appearance at
Morning-lane school, Homerton, in the autumn of 1918, and was short, sharp and severe. There were
12 cases in September and 33 in October, confined, with the exception of three cases, to the infants'
and girls' departments. The type of illness was severe. The school was repeatedly visited by assistant
medical officers, and large numbers of children were swabbed, with the result that many carriers of
diphtheria bacilli were discovered and excluded from school. The outbreak ceased as suddenly as it
appeared. On the other hand, in the schools in the immediate neighbourhood, Berger-road, Homertonrow,
and Orchard-street, which were also affected in 1918, though to a less extent, the disease persisted
endemically throughout 1919 and 1920.
The next outbreak occurred at Newington Green school in the borough of Islington. There was
no apparent direct connection with the Homerton prevalence, as the two groups of schools are two or
three miles apart.
The outbreak at Newington-green was confined to the infants' department, and commenced
in February, 1919, when four deaths occurred among children attending the same classroom. In
two of these cases the cause of death was not reported as being due to diphtheria but to a "septic
throat" and "chicken-pox which went to the throat "respectively. They were, however, undoubtedly
unrecognised cases of diphtheria. During the period February to July, 1919, 29 cases occurred, and
repeated visits of enquiry were made by the Council's medical officers. All the children attending
the infants' department, numbering 534, were swabbed, and of these 43 were found to be "carriers"
of diphtheria bacilli. No cases of diphtheria were reported in August or September, but cases commenced
to reappear in October, and continued to occur until March, 1920. There was a fresh introduction
of infection in September, 1920, which continued to the end of the year, when the outbreak
subsided.
The outbreak at Princess May-road school in the same group and within a mile of Newington
Green school did not occur until the end of 1920. As in the case of Morning-lane school, the period of
invasion was short (2 months) and the type of illness severe.
The prevalences in the Dalston group and Hoxton and Haggerston group followed hard upon
the heels of the Homerton epidemic, whilst the Islington outbreak, the most severe of the series, prevailed
in the latter half of 1920, and the early part of 1921.
A review of this local prevalence over the whole period of three years appears to indicate that
there were originally two separate epidemic centres, viz., at Homerton and at Stoke Newington. From
the Homerton focus the disease apparently spread southwards through Dalston, Haggerston, and Hoxton,
and similarly from the Stoke Newington centre of infection the epidemic followed a south westerly
direction towards the Islington group, the southernmost schools of which link up with the schools in
the, Hoxton area.
The effect of holidays, especially the prolonged midsummer holidays, upon the prevalence of
scarlet fever and diphtheria has frequently been discussed in these reports. The marked decrease in
the number of notifications received during August results from diminished exposure to infection on
the one hand, and decreased supervision of ailing children on the other. Regarding the latter factor,
non-attendance at school interrupts the supervision of teachers and school nurses, and undoubtedly
leads to mild cases of disease—more especially of diphtheria—escaping detection and notification;
but there are no means of determining the number of cases thus missed. They may be few in number,
but they are a potential source of infection when schools reassemble, a circumstance which has to be
borne in mind in interpreting what follows.
The decrease arising from diminished exposure of the children to infection during holidays is
accounted for first by limitation of contacts and secondly by absence of children from London. Some
time ago endeavour was made to determine the relative value of these two factors. Information was
obtained from a number of children as to the length of time they were away from London during the
summer holidays ; and from the resulting figures it was deduced that the average period of absence
was for all children of school age less than one week, and that the reduction in the child population
of London could be taken to be about 12 per cent. This percentage, therefore, of the total decrease
can be regarded as approximately due to holiday exodus.
61004 M 2
School
Holidays in
relation to
the spread
of Scarlet
Fever and
Diphtheria.