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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The medical officer of health says—
I am consequently bound to fall back on personal infection at school as the cause of the majority of
the cases amongst the scholars of the Daubeney-road Board School. On looking through the list there
appears to be an almost unbroken series of cases at this school from the beginning to the end of the period
treated of. Of course it is not possible to connect each case with a preceding one, neither is it at all
necessary. It is agreed upon by all competent authorities that during diphtheria prevalence there often
exist a large number of mild and unrecognised cases of throat disease, which are highly infectious and
competent to spread the disease amongst the healthy. It is not unknown for those who dispute the
importance of school influence in the spread of diphtheria to deny the existence of such mild cases as
those alluded to, but the matter has been established beyond all power of denial
Again, while making enquiries at the school as to the cause of this outbreak, I learned that several
scholars were absent. On inquiry at the homes of these children, it was ascertained that several were
suffering from sore throat and ulcerated throat; one or two of these were afterwards notified as
diphtheria. Having carefully considered the whole of the circumstances connected with the outbreak
amongst the scholars at Daubeney-road Board School, I am of opinion that the disease was spread chiefly
by personal infection at school, especially in the infants' department, the infection being conveyed largely
by means of unrecognised cases, for no doubt the head mister and mistress excluded'any cases immediately
they were recognised as diphtheria. How the disease was introduced it is impossible to say; probably
by an ill-defined case, or by some secondary case from an infected household.
The medical officer of health makes the following recommendations with a view to
preventing a recurrence of such an outbreak,
(1) That during periods of diphtheria prevalence, the children attending the public elementary schools
should be periodically examined by a medical man, in order to ascertain whether any of the scholars are
suffering from throat disease of any kind. (2) That children suffering from throat disease of any kind
should be immediately excluded from school. (3) That on the exclusion of any child from school on
account of throat disease, notice of such exclusion, with the class and department attended by child,
should be immediately sent to the medical officer of health for the district.
St. Saviour, Southivark.—The medical officer of health reports that in two days in the
early part of October, six children between the ages of 3 and 5½ years were certified to be suffering from
diphtheria, and the usual enquiries as to the schools they attended and possible sources of infection
elicited the fact that all the children belonged to the infant department of a school in the Christchurch
district. The medical officer visited this school and examined the infants attending there, with the
result that he found one case of undoubted diphtheria and four others which were of a suspicious
nature. The case referred to was sent to hospital, where his diagnosis was confirmed. The school was
accordingly closed and disinfected. On the re-assembling of the children he examined them all and
found no child suffering from diphtheria, and since that time no case of diphtheria occurred among the
children of that school.
Wandsworth (Putney and Roehampton).—The medical officer of health reports on an outbreak
of diphtheria in Roehampton. Nearly all the sufferers, 23 in number, were children from 6 to 11
years of age, and nearly all attended the National schools at Roehampton. There was no reason for
thinking that milk, water, or the condition of the houses was responsible for the outbreak. Certain
faults were found in the sanitary condition of the school, but the disease appeared to be due to personal
infection from one child to another. The school was closed for four weeks. No death occurred.

Gamberwell.—The medical officer of health gives account of an exceptional prevalence of diphtheria in 1896 in an area in Camberwell in which four schools are situated, and he supplies the material for comparing the incidence of attack in this area with that of the rest of Camberwell, both in 1896 and the preceding year. The following figures for these years are thus obtained—

Attacks at certain age periods per cent, of total attacks.
0—44—1313 and above.
1895Specially affected area The rest of Camberwell3 1.950.018.1
1896Specially affected area The rest of Camberwell21.160.018.9

A further point commented on is the falling off in the number of notified cases during August,
1896, when the schools were closed.
In March, 1897, I presented to the Council's Public Health Committee a memorandum on the
increase of diphtheria in that locality which will be found in the Appendix. (See Appendix I.)
Lewisham.— Reference is made in the report of the medical officer of health to prevalence of
diphtheria in this district. This prevalence was investigated by Dr. Hamer, on behalf of the London
County Council, with the result that it was found to be due to the infection of children in a Board and
National school. The outbreak presented no unusual features, and indeed the chief interest attaching
to it is the fact that it was the occasion of a report by the medical officer of the London School Board,
who traversed Dr. Hamer's conclusions. The Council's Public Health Committee instructed me to
comment on this report, and in obedience to this instruction I prepared a statement which, with
Dr. Hamer's report, will be found in the Appendix (see Appendices II. and III.). In connection with this
subject I have only to add that since these papers were published it has been found that the population