Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
[Report of the Medical Officer of Health for London County Council]
of a certain industrial school was not included in the population of an enumeration district in which the
institution was situated, but was separately returned. Some modification of Dr. Hamer's figures are
therefore necessary, with the result that the very strong evidence Dr. Hamer's report contains in
support of his conclusions is still further strengthened.* A copy of Dr. Hamer's report, and my own
observations on the report of the medical officer of the London School Board, were communicated by
the Public Health Committee to the Local Government Board.
Woolwich.—The medical officer of health, referring to increased prevalence of diphtheria in
The most careful investigation has been made with the view of determining the cause of the increased
prevalence of diphtheria, but with no satisfactory result. Crops of cases occurred in the neighbourhood
of three schools, viz., Eglinton-street and Union-street Board Schools and St. Thomas Church School.
In no single instance could any possibility of infection at school be found. The sanitary arrangements
in all the houses attacked were good, but in three or four cases overcrowding was found. Notices have,
however, since been served, and the conditions remedied. In no instance could the disease be traced to
the milk supply.
Plumstead.—The medical officer of health writes, " The south-west ward was more affected than
in recent years. Bloomfield and Ancona road schools were most affected.
For the purpose of ascertaining whether, as in previous years, there was decrease of diphtheria
prevalence among children of school ages during the summer holiday, diagram XI. has been prepared.
The summer holiday of the schools of the London School Board began at noon on Thursday, 23rd July,
or the later part of the 30th week, and the schools re-opened on Monday, the 24th August, or the
beginning of the 35th week.
The diagram shows a decrease in the number ot attacks among children aged 3-13 in the 32nd-35th week, a decrease among infants being manifested a little later, suggesting, as I have before pointed out, a lessening of the infection of the younger by the older children. If the number of cases in the four weeks which would be most subject to the influence of the holidays be compared with the numbers in the four preceding and subsequent weeks the following results are obtained—
|Period.||Notified cases—Ages.||Increase or decrease per cent.|
|0 - 3||3—13||13 and upw___is.||0—3||3—13||13 and upwards.|
|Four weeks preceding weeks of holiday influence ('28th to 31st)||170||643||287||—||—||—|
|Four weeks of holiday influence (32nd to 35th)||154||547||300||— 9.4||—14.9||+ 4.5|
|Four weeks following weeks of holiday influence (36th to 39th)||183||733||278||+ 18.8||+ 340||—7.3|
Diphtheria—Proportion of cases and deaths in hospitals.
In diagram XIII. will be found the proportion of London cases of diphtheria admitted into the
hospitals of the Metropolitan Asylums Board in 1896, and the proportion of the deaths from this
disease which occurred in these institutions in that year. These proportions were nearly the same as
Bacteriology as an aid to diagnosis.—Arrangements have been made in several districts to
afford facilities to medical practitioners for the bacteriological examinations of material from doubtful
cases of diphtheria. In St. Pancras, Holborn, St. Marylebone and St. Olave arrangements have
been made and the necessary facilities given to medical practitioners for transmitting such material for
this purpose. In the Strand, arrangements of a like kind came into force in 1897. In St. Marylebone
material from 87 cases was examined with positive results in 46 ; in Holborn material from 17 cases was
examined, with positive results in 10; in St. Olave material from four cases was examined; in
Camberwell, Woolwich and Plumstead recommendations to adopt a similar course have been made by
the medical officers of health of these districts.
Diphtheria—Age and sex distribution.
The age and sex distribution of the cases of diphtheria notified in London during 1896 are
shown in the following table. Females during the first four years of life were attacked in a smaller
* The industrial school, being a public institution with over 100 inmates, is dealt with separately in the census returns. The
figures on pages 4 and 5 of Dr. Hamer's report require, therefore, some amendment if, as was originally intended, the population of the
industrial school is to be included. This population at the census of 1891 comprised 156 persons, of whom 1 22. 119 and 14 belong to
the age-groups 0-3, 3-10, 10-15 and 15 and upwards, respectively. I have had the figures, which result upon inclusion of this population,
worked out. The proportions shown on the last line of the table on page 4 of Dr. Hamer's report, become 177 in place of 174 at age 0-3,
396 in place of 394 at age 3-10, 82 in place of 92 at age 10-15, the figure 12 given for the age 15 and upwards being unaffected. Again,
the slight alteration produced in the attack rates given on page 5 renders it necessary to substitute "more than twice" for "nearly
three times "in line 37; "more than 4" for "4½" in line 39; and "67" for "70" in line 41. The teaching of these figures, it will be
seen is thus not materially affected by inclusion or exclusion of the industrial school population.
The belief that the industrial school population was included in the total 1,726, given as the number of children aged 3-12 living
in the area, led Dr. Hamer, however, to considerably underestimate the number of children aged 3-12 attending other schools than the
board and national schools, or not attending any scho 1 (see his report, top of page 6, and footnote). The total number of children at
the age of 3-12 should be 1,803 in place of 1,726 (77 inmates of the industrial school being between the ages 3 and 12). Hence "about
300" in line 5 becomes "about 450,"and the excessive incidence of disease upon the children attending the board and national schools,
as compared with other children belonging to the same age-group, is seen to be 50 par cent. higher than Dr. Hamer had supposed to be