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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dissemination of the disease, and that the infants' department of the school was the principal medium
of transferring the infection from family to family, so, acting under my advice, the school authorities
closed the infants' department on December 10th, with the result that the cases at once ceased.
In Poplar a number of cases of diphtheria occurred in the neighbourhood of the St. John's
National School in the Isle of Dogs. "Upon the 12th November," the medical officer of health
states, "the number on the roll was 113, and with diphtheria there were 15 scholars absent (13.2
per cent.). In the babies' department, the number on the roll was 73, and with diphtheria there
were 6 absent (8.2 per cent.).'' On the 19th November the proportion absent was greater and the
whole school was closed.
In Plumstead cases of diphtheria occurred among the scholars of Knee-hill Board
School, concerning which the medical officer of health, Dr. Davies, reports as follows—
On April 4th I reported to the vestry that 10 cases had occurred in connection with Knee-hill
School, "that there has only been one case of diphtheria recently in the Erith side of Abbey-wood. The
evidence points plainly to the Knee-hill School being the probable source of the prevalent diphtheria at
Abbey-wood, I have written to Professor Smith on the subject. I think this is just a case where all the
children attending the school should be examined for latent diphtheria. The drains have been tested by
the School Board and found satisfactory." Unfortunately, by the School Board's direct prohibition, I
am not allowed to examine children in their schools myself. In consequence of a further report, dated
16th May, on the continued prevalence of diphtheria at Abbey-wood, in which I stated that as I could
not examine the children and exclude the suspected ones, the only way would be to close the whole
school, the vestry directed a letter to be sent to the School Board asking them to allow me to examine
the children. The Board did not grant this request, but apparently as a result of it, one of the Board's
medical officers came down on the 23rd and 25th May, and examined the children, and certain ones were
excluded. After these steps, delayed unfortunately so long, eight cases occurred, but all were secondary
cases with one exception, i.e., only one home was invaded which had not been already affected. I learnt
afterwards that two of the children excluded were found to have the diphtheria bacillus in their throat.
I visited the home of one of these, and warned the mother as to keeping her children away from school,
and as to disinfection of the mouth and throat; but the other child had been moved from the locality
before I heard of the exclusion.
In Clapham parish a few cases occurred among boys attending the Bonneville-road Board
School, the circumstances of these cases are interesting because in this case also the course was
adopted of medically examining the children attending the school. Dr. Field's report states—
"During November, four cases of diphtheria were notified in boys attending the school. On enquiry
it was found that there were other cases among scholars in the same room who lived outside Clapham
parish, and as to whom I had, of course, had no notification. It also appeared that all the boys had their
seats in the same part of the room. Suspecting that there might be a boy in an infectious condition in
this part of the schoolroom, I, with the assistant to the medical officer of the School Board, examined the
throats of a considerable number of boys. We found two with throats suggestive of diphtheria, and clearly
infectious. These boys were sent home, and not allowed to come back to school till certified as free
from infection by their doctors. Excepting one further case, that of a boy who was already ill at this
time and was notified two days subsequently, there were no more cases reported in connection with this
school. These boys looked ill at the time, and would no doubt have been kept at home by parents
belonging to a more educated and careful class. This confirms my opinion that much more could be done
in preventing the spread of this disease by the examination of children attending elementary schools
by a medical man."
The need for medical examination of children attending school at times when the school
is suspected of causing the spread of diphtheria has long been evident, and the adoption of such
a course may be expected to materially reduce the need of school closure, and thus to prevent
the interruption to education which school closure involves.
For the purpose of ascertaining whether as in previous years there was decrease of
diphtheria prevalence among children of school age during the summer holidays, diagram XV.
has been prepared. The summer holiday of the schools of the London School Board began
on Thursday, the 26th July, i.e., the latter part of the 30th week, and the schools re-opened on
Monday, the 27th August, i.e., the beginning of the 35th week. If the number of cases in the
four weeks preceding and four weeks subsequent to the weeks most subject to holiday influence
be compared, the following results are obtained for the age periods of 0—3, 3—13, and 13 years
and upwards. It will be seen that the decrease in the number of cases notified during the
period of holiday influence, and the increase in the subsequent period is most marked at the
school age.

Diphtheria—Notified cases,1900.

Period.Notified cases—Ages.Increase or decrease per cent.
0—3.3—13.13 and upwards.0—3.3—13.13 and upwards.
Four weeks preceding weeks of holiday influence (28th to 31st)127616217
Four weeks of holiday influence (32nd to 35th)134417162+5.5—32.3—25.3
Four weeks following weeks of holiday influence (36th to 39th)151606200+12.7+45.3+235

In my last annual report I published a table showing the percentage of total notified cases
of diphtheria occurring at ages 3-13 for, the three years 1897-1899 in each of the London sanitary
areas. The following table gives similar information for the five years 1896-1900.