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Westminster—Several cases of diphtheria occurred during October and November among
children attending the St. James-the-Less Infant School, Upper Garden-street. The medical
officer of health gives the following particulars—
"The first case occurred in the main room in a buy who was attacked on October 21st; the
second case occurrc 1 in the class-room on October 27th ; the third case in the main room on October 28th,
in the person of a girl who sat next the boy referred to. On November 1st the boy who sat next the girl
just mentioned was taken with the disease, and the girl who sat next this boy was taken with diphtheria
on November 4th. I may also state that in all these cases, except one case, they all lived in different
streets some way distant from each other, and in the one case mentioned of the two children who lived in
the same street, their houses were some distance apart from each other."
St. Pancras—The prevalence of diphtheria amongst the scholars of the Board School,
Haverstock-hill, necessitated the closure of that school just before Christmas for a month.
Stoke Newington—The medical officer of health writes that "School attendance is either
alleged by the parents or surmised by myself, on good grounds, to be the cause of three attacks
during the year, and to be responsible for 5.7 per cent. of the cases, as against 7.5 per cent. in the
preceding year."
Hackney—Cases of diphtheria, varying from one to four each week, occurred from the first
week of January to the last week in, May, with the exception of one week in March, amongst the
scholars attending the Rushmore-road School. In all, 44 children were attacked, of whom 37
were infants. Several other infants were at the same time away from school suffering from sore
throat, or mumps. The percentage attacked in the different classes varied from 1.6 to 15.5, the
latter rate obtaining in the babies' class.
A second outbreak of diphtheria occurred during the months of March, April, May, and
June in the infants' department of the Tottenliam-road Board School. The disease was thus distributed:
Two cases in the boys' department, five in the girls', and thirty-two in the infants'
department. The incidence of attack on the several classes of the infants' department varied from
4.5 per cent. to 24.3 per cent. of the average number of children attending the classes.
Dr. Warry thus writes—
"It should be noted that the latter figures (24.3 per cent.) represents the extent to which class IV.
suffered—equal nearly to one child out of every four. This heavy incidence cannot be the result of
mere chance; indeed, both in this classroom and the corresponding class-rooms of the Rushmore-road
Board Schools, the conditions are such as in my opinion must favour the spread of infectious disease, if
by any chance a case is introduced. I refer to the kind of desks and their arrangement in these classes.
The desks are long with seats made to sit six children side by side. At the time of my visit to the
schools the seats were packed, the children apparently keeping each other up. This arrangement is one
which I have expressed before as being likely to lead to the spread of disease from child to child; and I
repeat that I consider all infants should be separated from each other during school life by seating them
at single desks and seats in the manner practised for adults in some schools.
The floor space of the two class-rooms in question is, in my opinion, insufficient. It varies, of course,
according to attendance, but it works out for Rushmore-road class-rooms at about 6 square feet per
child, and at the Tottenham-road class-rooms at about the same floor space per child. The floor space
should not be at any time much less than 15 square feet per scholar.
In discussing these outbreaks, Dr. Warry insists upon the part played by unrecognized
cases of diphtheria in disseminating disease, cases so mild as to escape the observation of both
parents and teachers, or if noticed " which are dismissed with the appellation of ' slight sore
throat,'" and he adds, "Such cases have been proved to possess the power of infecting healthy
persons with a recognizable form of diphtheria. The presence of such cases may be demonstrated
in almost every outbreak of diphtheria if inquiry be only made at the homes, or the throats of the
children examined. Wherever diphtheria exists, there will also exist, in addition, numerous cases
of sore throat. This I have observed several times."
Shoreditch—During the year inquiries were made into the circumstances of 205 of the cases
of diphtheria certified in Shoreditch, and Dr. Brvett states: "In 94 cases the patient was a child
attending school, and in 78 instances the child had been attending school within one week of the
onset of symptoms. In 69 other cases, although the patients were not children attending school,
there were children, members of the patients' families or living in the same houses, who were
attending school. In a few cases the patients must have been attending school whilst suffering
from the disease before it was recognized as diphtheria. In the majority of instances the houses in
which the cases occurred were in satisfactory condition. In 37 instances there were histories of
throat illness amongst other persons residing in the houses where the patients lived. Several of
these were cases of diphtheria which had been previously, or were subsequently, certified."
Mile-end Old-town—Dr. Taylor writes: "There was, and always has been: a marked
diminution of this disease during that part of the summer when the schools are closed, tending
to show that school attendance has a marked influence as to its spread. We take all the precautions
we are able to prevent its spread, and with that in view I have suggested that the children
from any infectious house should not be allowed to return to school until one month after the case
is removed to the hospital, or at least 14 days after the patient has recovered if treated at home.
I am quite convinced that many children convey infection to school if sufficient interval is not
allowed to elapse between the notification and school attendance."
Poplar—The number of cases of diphtheria aged from 3—10 per cent, of the total notified
cases is given as follows—1894, 39.9 ; 1895, 50.6 ; 1896, 55.5; 1897, 61.6 ; 1898, 60.0.
St. George-the-Martyr—The medical officer of health recommends the frequent and systematic
inspection of all schools, "as it is in such places that early and undetected cases of diphtheria, in
the sore throat stage, are to be found under circumstances that afford every opportunity for the
spread of infection."
Newington—The medical officer of health writes: "Of the schools, Victory-place School,
Sayer-street, Crampton-street, Westmoreland-road Board Schools, and Sutherland-square Church
School, were those whose pupils were most affected. I was able to prove, after a full investiga-