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London County Council.
DIPHTHERIA IN LEWISHAM.
Report of the Medical Officer of Health, presenting Dr. Hamer's report on an outbreak
of Diphtheria in the district of Lewisham.
(Printed by order of the Public Health Committee, 12th November, 1896.)
On the 15th October the Public Health Committee instructed me to report to them on the
circumstances of an outbreak of diphtheria in Lewisham. The following day, accompanied by Dr.
Hamer, I called on the clerk and medical officer of health of the Lewisham District Board at the
board's office.
It had been ascertained that a considerable number of cases of diphtheria had occurred among
children attending the Lewisham Bridge Board School, and that a smaller number had occurred among
children attending the St. Stephen's National School, but it was not known to what extent the schools had
actually contributed to this prevalence, and particularly whether the schools were at the time operative in
spreading the disease. This evidently was the point which needed first to be determined, and it was
arranged that Dr. Hamer should at once proceed with an inquiry with this object. In the mean time I
thought it was desirable that a medical examination should be made of children still attending school so as
to ensure as far as possible the exclusion from attendance of any child whose state of health suggested
that it might be a source of danger to its schoolfellows. In a very short time Dr. Hamer had ascertained
that whatever part the schools had played in contributing to diphtheria prevalence earlier in the outbreak,
this influence was not then operative. A few fresh cases of diphtheria, it was true, were occurring, but
these were in all instances limited to persons belonging to families having no child then attending either of
these schools. Indeed, subsequent to the beginning of Dr. Hamer's inquiry only two school attendants were
attacked, the one attending the Board school the other the National school. So far as the schools were
concerned, the action of the sanitary authority was therefore limited to the examination of children, and
the disinfecting, first of the Board school, and later of the National school.
Dr. Hamer's inquiry was then directed to ascertaining the cause of the outbreak. He found that
as long ago as the preceding year the neighbourhood, in which these schools were situated, had begun
to suffer from an amount of diphtheria somewhat in excess of that which had been observed in previous
years, and in the few weeks antecedent to the August holiday several cases of throat illness had occurred
among children attending school. Within a fortnight after the schools reopened cases began to manifest
themselves among school children, who were the first persons in their respective families to be attacked.
From the facts ascertained by Dr. Hamer, it is clear that up to the middle of September the incidence
of such attacks was mainly on the younger classes of the boys' department of the Board school, and that
later the disease affected chiefly the infants' department of the Board school and the girls' department
of the National school.
There was no evidence forthcoming that milk, or indeed any other condition than that of personal
intercourse, was responsible for the earlier cases, and Dr. Hamer's report conclusively shows that the
larger prevalence of September and early October was due to disease contracted at school.
The question necessarily arises whether closure of the Board school would have limited the
spread of the disease, and in this connection the coincidence in point of time between the termination
of the attacks affecting school attendants and the decrease in the number of children attending the
school through the action of parents is instructive.
It is deserving of note that unrecognised diphtheria in a boy whose illness occurred in early
September was very likely responsible for much of the prevalence which followed, and there is certainly
a probability that, if the younger classes of the boys' department had been closed at an early stage, this
course would have been productive of good. But unless the exclusion had extended to the brothers and
sisters of those attending excluded classes, such action would not have had the effect of excluding from
the infants' classes two brothers of the boy who had suffered from unrecognised diphtheria, and
who may possibly have been concerned in infecting their class-mates. After the invasion of the infants'
department of the board school, nothing less than the closing of that department and the younger classes
of the boys' department would have sufficed.
Dr. Hamer's observations as to the duties of the staff of inspectors and as to the need of a
shelter for the accommodation of persons whose rooms are undergoing disinfection should receive the
attention of the district board.
Shirley F. Murphy,
Medical Officer of Health.
No. 315. Price 4d. Sold by Edward Stanford, 26 and 27, Cockspur-street, Charing-cross, S.W.
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