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

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London County Council 1900

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

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children attending that school, the following being the cases notified subsequent to the reopening of the school on August 27th, after the summer holidays—

Child.Department.Date of notification.Last attendance.
M. H.Boys'(1st standard)September 21stSeptember 17th.
A. F.Infants' (Class A)„ 22nd,, 21st.
F. S.Boys' (3rd standard) ...October 6thOctober 4th.
F. S.,, ,,„ 15th„ 12th.

The last two boys lived in neighbouring houses and played together, and there is reason to believe
that there had been a mild unrecognised case in the house of the boy first notified. Nine other members
of the families of the two boys were subsequently attacked.
On October 15th two children were notified who, I was informed, had attended class room "H,''
infants' department, up to October 12th, but I have since ascertained that I was misinformed respecting
C. S., and that he attended class "F," and that it was his brother who was in class "H." On
October 19th, a boy in Langford-road, not attending any school, was notified as suffering from diphtheria,
and on making enquiries I found that his sister had been attending class "H" up till October 16th, and
was said to have had, prior to that date, a "cold and slight sore throat"; and on bacteriological examination,
the bacillus diptheriæ was isolated from the nasal secretion, so that it would appear that this
child was attending class-room "H" while in an infective condition. On October 20th and 22nd, two
children were notified who had been attending class "H" up to October 19th, and, at my request, the
headmistress of the infants' department furnished me with the names of twelve other children who
were said to be absent from that class on account of illness. These I visited, and three of
them I found to be suffering from undoubted diphtheria, two of whom had been attending class "H"
up to October 19th while the third had been sent home ill from that class on the day I saw her, viz.,
October 22nd. I also found two other children who then showed no clinical signs of diphtheria, but had
a history of some slight throat trouble, and on bacteriological examination, the bacillus diptheriæ was
isolated in each case.
Therefore, since October 12th, in a class with an average attendance, since the holidays, of 90, and
with 110 on the roll, there had ben six cases of diphtheria of a rather severe type, viz.—
F. S., last attendance, October 12th.
1. D„ „ „ 19th.
L. B., ,, ,, ,,
H. N. ,, ,, ,,
J. F., „ „ ,,
P.F., ,, ,, ,,
Of these, 5 had, so far as I could ascertain, no relations with each other except in school, their
homes lay in opposite directions, and there had been no other cases in them; in fact up to that time,
in three of the roads, no case of diphtheria had been notified of late, so that there was a very
strong presumption that at any rate the four who were simultaneously attacked, were infected bysome
child attending the class. Moreover, in addition to these, there were the three other children
who had been attending that class, who, though showing no clinical signs of diphtheria at the time
of my inspection, had suspicious previous histories, and from whom the diphtheria bacillus was
subsequently isolated. Hence, having regard to the prevalence of the disease in the district, its
special incidence on the children attending this class, and my knowledge that not only had they been
exposed to the infection of mild, or perhaps I should say, bacteriological diphtheria, but also to
that of acute diphtheria in the person of P. F., who was sent from school so suffering, I had no
hesitation in advising the sanitary authority to require the closure of that class-room, and also the
exclusion of the children living in the same houses, as otherwise there was, in my opinion, grave
danger of a more general outbreak in the school.
There was, I considered, no reason for any further steps to be taken at that time, as the rest
of the school was not affected. The only other recent case in the remaining classes of the infants'
department, with some 600 children on the roll, was one in class "F," and at that time, as I have
stated, I was under the impression that this child was attending class " H."
In the boys' department, in addition to the two cases in Standard 3 above-mentioned, a boy in
Standard I was notified on October 21st, and on enquiry, I ascertained that on October 14th, a boy
sitting next to him had vomited when in school, been absent for a few days ill, and had then
returned to school; but on examining him in school, I found him suffering from mild diphtheria,
and at his home found his sister, who had been attending the infants' school, and had sickened
after him, suffering from the disease in a severe form, neither case having been notified. There
have been, however, no other primary cases notified in this department up to the present time.
In the girls' department there had been no case up to the time of the closure of class "H,"
but since then four cases have been notified, viz.—
October 25th 2nd Standard.
29th 4th
November 4th 5th „
„ 14th 2nd „
but one of these was found, after admission to hospital, not to be suffering from diphtheria.
After the closure of class "H" on the 26th October, and the exclusion from school of the other
children from the same houses, the head-mistress continued to furnish me with the names of those
absent on account of alleged illness from other classes. From class "G," which adjoins class "H,"
there were several absentees, and one of them I found to be suffering from undoubted diphtheria,
although not notified, while two others, though showing no clinical signs of diphtheria, had a history
of slight sore throat, and on bacteriological examination, the bacillus diphtherias was found. There
were, however, no further cases in the infants' department until November 4th, when a child was
notified, who had been excluded from school in consequence of her brother being in class "H," and
on enquiry, I was informed that he had been somewhat unwell, prior to the closure of the class, and
on bacteriological examination, the diphtheria bacillus was isolated, so that, but for the closure of the
class-room, this child would have continued attending in apparently an infective condition. Two days
after this, a child in the next house, attending school, who had played with these children was notified.
Since then, two cases have been notified in classes "B" and "E," infants' department, on
November 16th and on November 20th respectively, and one of these was probably infected by a child
in an adjacent house, with whom he played, so that although the disease had continued prevalent in the
district, there has, since the closing of class "H," been no exceptional incidence upon the children
attending the school.
With regard to the question raised by the School Board, "that children cannot be legally
excluded from obtaining proper educational advantages when not resident in infectious houses," it