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is of course beyond my province to express any opinion, but I may remind you that the steps taken
in this case have been no new departure on the part of the sanitary authority, as it has always been
their custom, when ordering the closure of a particular class, to also require the exclusion of the
other residents in the homes of the children of the closed class, and the extracts from my annual
reports which will be found in the appendix to this report, furnish several instances of this proceeding.
I may point out that if the partial closure, hitherto requested by the sanitary authority, cannot
be enforced, the alternative will be, in cases similar to these, to close either the entire department
or the whole school, with the result that there would be, in either case, an interference with the
education of a much larger number of children. In the present case, by the method adopted, there
were excluded from school—
Infants' Department, including those in class "H" 210
Girls' „ 69
Boys' „ 67
346
while in the whole school there were—
Infants' Department 702
Boys' „ 514
Girls' „ 583
1,799
so that interference with education was minimised in a marked degree.
The experience I have had of these class outbreaks leads me to believe that they are usually
due to the attendance at school of a child or children suffering from unrecognised diphtheria, and
the best course, in my opinion, to check any further spread of the disease, is to promptly close the
infected class, and as it is always probable that some other members of the class have been already
infected, and as the relatives of the unrecognised case or cases have also been exposed to infection,
it is certainly necessary, if partial closure is to be effective, to also exclude the children living in
the same houses as the children belonging to the infected class.
By this immediate action I believe that the risk of the invasion of the whole school is materially
lessened, and the subsequent closure of the whole school possibly obviated.
In Chelsea, during March, April, and early May, over 60 per cent. of the cases of diphtheria
notified in the home district were children attending or living in the' same house with a child
attending a Board school in the central part of the parish, "the same school," Dr. Parlies writes,
"as that concerned in the propagation of the epidemic in 1896. The majority of these children
were in the infants' department, two were in the girls', and one in the boys' department. No cases
occurred in connection with the school after the 13th May." Dr. Parkes also states that four
cases occurred among children attending a Church school. "In this instance also the
iufection appears to have spread from one child to another during school attendance, although
an interval of a week elapsed between the sticcessive cases."
In Westminster, Christ Church Schools were closed on two occasions at the request of the
medical officer of health, once in January for five days, and for a few days, eight weeks later, on
account of two cases of diphtheria occurring in the schoolmaster's family residing on the premises.
In Stoke Newington one school was temporarily closed "on account of a school outbreak
of diphtheria."
In Shoreditch, between the 10th October and the 20th December, 18 cases of diphtheria
occurred in the neighbourhood of Scrutton-street Board School among children living for the most
part in artisans' dwellings. Dr. Bryett writes: "The principal thing in common amongst those
attacked was attendance at the infants' department of the Scrutton-street School, for practically the
whole of the sufferers were children attending the department or had been brought into contact with
children attending the department. Upon the school closing for the Christmas holidays the cases
ceased." Dr. Bryett also gives an interesting account of the occurrence of cases of sore throat
associated with cases of diphtheria among children attending another school in Shoreditch. The
circumstances of this outbreak deserve to be stated in detail and the following is therefore
extracted from Dr. Bryett's annual report—
Towards the end of November my attention was attracted by the occurrence of several cases o
diphtheria in households from which there were children attending the Mintern-street Middle Class
School, and upon enquiry I ascertained that there had been, besides the cases certified as diphtheria,
several other cases of "sore throat." The cases amongst the school children were practically confined
to those attending the infants' department, which numbered at the time of the outbreak 110. The
history of the outbreak showed that during the first fortnight of November a case or two of "sore
throat" had occurred amongst the members of a family living in a house in Cavendish-street. On or
about November 19th a little boy belonging to this family was taken ill with a "sore throat," and was
subsequently aertified to be suffering from diphtheria. At the time he was taken ill he was attending
the infants' department of the school mentioned. On November 21st or 22nd, one of the teachers in the
infants' department was taken ill with a "sore throat." She taught in the school however until mid-day
on November 23rd, when she became too ill to continue. This teacher was subsequently certified to be
suffering from diphtheria. Then followed a series of 15 cases of throat illness in houses from which
children were attending the infants' department of the school. The majority of the cases were certified
to be diphtheria. In one instance, in which a bacteriological examination was made, the specific microorganism
of diphtheria was present. The cases were distributed as follows—two, one of diphtheria and
one of "sore throat," at houses in St. John's-road; one of diphtheria at a house in Mintern-street; two,
one of "sore throat" and one of diphtheria, at a house in Buckland-street; six, all of diphtheria, at a
house in New North-road; one case of "sore throat" at a house in Balmes-road, Hackney, and three
cases of diphtheria at a house in Bevenden-street. Of the six cases at the house in Now North-road,
three were of children attending the infants' department, and the other three were adults who were
probably infected through contact with the children. Of the three cases in Bevenden-street, two
doubtless resulted through infection from a child, a member of the family, who was attending the
infants' department, and had been home from school for several days suffering with what was at first
regarded as a " sore throat," but which was afterwards found bactcriologically to be diphtheria . . .
The indications were that infection from person to person, direct or indirect, was the chief factor in the