London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1896

[Report of the Medical Officer of Health for London County Council]

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There are therefore in the affected area four groups of persons at ages 3-12—
(a) 9711 attendants at the Board school, of whom 31, or 3'2 per cent, were first sufferers.
(b) 4081 ,, ,, National ,, ,, 9 „ 2.2 ,, „
(c) 150t inmates at the Industrial ,, ,, none were first sufferers.
(d) About 300* children, aged 3-12, attending other schools, or not attending school
at all, of whom 3,+ or 1 per cent, were first sufferers.
The incidence of diphtheria upon the Board and National schools is thus seen to be quite
unmistakable; moreover, the Board school has suffered to a somewhat greater extent than the National
With regard to the sanitary condition of the Board school and National school careful investigation
was made by the officers of the Lewisham District Board with result that no drainage defect which
can be regarded as having influenced the spread of diphtheria was discovered in either school.
The question as to the part played by personal contagion now requires to be considered. On
making inquiry as to which class in the school was attended by the first sufferers in affected households,
it transpired that the two schools to which attention has been directed were by no means affected equally
throughout their whole extent. Thus, limiting consideration always to the case of first sufferers in
families, it was found that the "girls" attending the Board school had suffered to a much less extent
than the "boys" and "infants," and, further, that while the upper classes in the boys' school had
escaped, the three lowest classes had suffered most severely. In the National school the "boys" had
escaped altogether, and so had the upper classes of the " girls;" the lowest class of the girls had,
however, suffered severely, and cases had occurred amongst the infants.
It appears desirable to give the facts observed in some detail, and the annexed table has
therefore been prepared, showing the dates of attack in the case of first sufferers in families, and the
school attended, and indicating, in the case of school attendants, the class to which the said first
sufferers belonged.
In this table attention has been directed not only to cases notified as diphtheria, but also to cases
of sore throat, concerning which knowledge was forthcoming, and in those instances in which such
sore throat preceded a throat illness which was recognised as diphtheria, the person manifesting the
sore throat has been classed as a " first sufferer." In all instances in which the disease was notified as
diphtheria or membranous croup, the letter D is used to indicate the case ; in instances in which the
sore throat attacking a " first sufferer " was not notified, the letter S is used.
From the data afforded by this table, and with a knowledge of the average attendance in each
class of the Board and National schools, the percentage of children attending each class who were
attacked can be obtained. In calculating these percentages the average attendances during the week
ending August 28th, have been taken, and all cases in which the throat illness commenced after the
summer holidays, and prior to October 11th, have been included.

The following are the results obtained— Percentage of Children in each class attacked (First sufferers).

Board School.National School.

Hence in each of 9 classes upwards cf 5 per cent, of the children were attacked. It will be noted
that the boys' department at the National school altogether escaped, and that the attacks in the girls'
department affected one class only. In the girls' department at the Board school comparatively few cases
developed, and the last class in this department presents a striking contrast to the corresponding class
at the National school. In the infants' department at the Board school, classes I. and II. occupied one
room, as did also classes IV. and V. Class VI., the " babies," had a room of its own, and suffered
comparatively slightly, while class III., which also had a room of its own, escaped altogether.
If the proportion of first sufferers in children attending the 9 classes most affected be compared
with the proportion of first sufferers in other children of the same age in the affected area in this period,
the former group of children will be found to have suffered at a rate eight times the rate of the latter.
Consideration of what has been stated and an examination of the annexed table shows that,
without doubt, particular classes in these two schools were largely operative in disseminating disease.
It is worthy of note that the several departments of the two schools were not equally affected in
point of time. The boys' department of the Board school was already involved for more than a week
before the special incidence upon the infants' department of the same school, and upon the lowest class
of the girls' department of the National school, was developed. It will also be noticed that cases of
throat illness affecting boys belonging to the Board school occurred during the latter part of July. The
history of cases of diphtheria occurring in the affected area for some time prior to the school holidays
has been enquired into, and it transpires that children attending both schools had been attacked before
the holidays; and in some instances there are indications that disease had spread by means of mild
cases of illness, the nature of which had not been recognised.
†These numbers include a certain number of children over 12, and there is therefore a slight understatement of the incidence
upon the age period in question at the Board and National schoolo. ...
* This number is arrived at by adding to the 1,726 persons, at the age period 3-12 living in the area, 100, as being the number
belonging to the orphanage which is not included in the area, and then subtracting the numbers given under (a), (b) and (c).
‡It may be noted that two of these three children appear to have been infected by children who were school attendants