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London County Council.
THE RECENT OUTBREAK OF DIPHTHERIA IN LEWISHAM.
Medical Officer to report on the report of the Medical Officer of the London School
Board as to an outbreak of diphtheria in Lewisham.—Public Health Committee,
4th February, 1897.
In obedience to the instruction of the Committee, I beg to submit my observations on the
report of the medical officer of the London School Board on "an outbreak of diphtheria at Lewisham
and its alleged connection with the Lewisham-bridge Board school."
This report was prepared by the medical officer of the London School Board in response to
a resolution of the School Management Committee of that Board referring to him a report by Dr.
Hamer, which I had presented to the Public Health Committee of the Council.
It will be recollected that Dr. Hamer, as the result of his inquiry, had come to the conclusion
that this outbreak was in the main due to disease contracted in the Lewisham-bridge Board school
and the St. Stephen's National school.
The chief reasons which led Dr. Hamer to this conclusion may be briefly summarized. He took,
for the convenience of statement of the circumstances of the outbreak, an area consisting of five
enumeration districts, which was that specially affected, and which had a known population, this
population having been enumerated for the purposes of the census of 1896. This he called the
"affected area." Considering the cases of diphtheria which occurred within this area, he found that—
1. There was a special incidence of the disease upon children who were of school age.
2. This special incidence was manifested in greater degree when consideration was
limited to first sufferers in affected households.
3. Among children, aged from 3—12 years, who were first sufferers in households, those
attending the Board and National schools suffered in greater degree than those not attending
these schools. Children attending the Board school suffered more than four times, those
attending the National school more than three times, as frequently as children not attending
these schools.
4. When the distribution of these cases (first sufferers) in the several classes of these
schools was considered it was found that certain classes were specially affected. A greater
incidence of disease was therefore found on children attending these classes than on children
attending these schools generally, and a much greater incidence on children attending these
classes than on children not attending these schools.
With respect to No. 1, study of the report of Dr. Smith, the medical officer of the London
School Board (page 3, last paragraph), shows that he recognizes that " the special incidence has been
on children of school ages," but throughout his report he offers no explanation of this circumstance.
With respect to No. 2, Dr. Smith raises no objection. He publishes, however, a table (B) on page
16 of his report which shows the ages of persons who had first and subsequent attacks " in the parish
of Lewisham and its immediate vicinity." In thus analysing the ages of persons who had first and
subsequent attacks in a large area, he necessarily includes cases which are not connected with the
outbreak under consideration. His figures, notwithstanding, teach the same lesson as those of
Dr. Hamer, but again he offers no explanation of this circumstance.
With respect to No. 3, Dr. Smith thinks that Dr. Hamer's "estimate of the small number of
children not attending schools is so liable to error as to be practically useless for the purposes of
comparison."
It is necessaiy here to show how Dr. Hamer arrived at his estimate. In the first instance he
ascertained that the average numbers of children attending the Lewisham-bridge Board and National
schools in the week ending 28th August were 971 and 408 respectively. Some proportion of
these children did not live in the affected area; indeed, among the children in the National
school were 100 children living, in an orphanage situated outside the affected area. To
estimate the number of children between the ages 3—12 living in the affected area attending other
schools or not attending school, he deducted from the total number of children of this age living in the
affected area (1,726)* the 971 children in the Board school and the 408 (less 100 children) attending the
National school, and he thus arrived at the figure 447, 150! of which were living in an Industrial school
situated in the affected area. He was thus able to compare the incidence of disease upon four
populations, one which attended the Board school, another which attended the National school, a
third which lived in the Industrial school, and a fourth (about 300 in number) which attended other
schools or did not attend any school.
Dr. Smith takes exception to this estimate of 300. He is of opinion that Dr. Hamer should
have included in his Board and National school populations not the average number attending during
*This figure was arrived at by the U9e of the census figures of 1891 and 1896.
†None of these 150 children were attacked.
No. 323.—Price 2d.] Sold by Edward Stanford, 26 and 27, Cockspur-street, Gharing-crons, S.W. [496—3149