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Account is given in the annual reports of the occurrence of outbreaks of diphtheria among school
children, and in all such instances the Klebs Loeffler bacillus was detected in some of the children.
Thus, Dr. Jackson gives account of such occurrences in the Hugon-road school, the Clancarty
school, the St. Dunstan's school, and a private school, all in Fulham. In all these schools either cases
of clinically recognisable diphtheria or children harbouring the diphtheria bacillus were subsequently
discovered. Only in the case of the last school was closure resorted to. In Chelsea, cases of diphtheria
occurred among the scholars of the Walton-street school. Dr. Parkes writes that the school was eventually
closed on the 5th April until after the Easter recess, but on the reassembling of the children other
cases occurred among them. On November 14th, 115 of 550 of the boys in the Duke of York's school
were found to be harbouring the diphtheria bacillus. Sore throat in an epidemic form had been prevalent
among the boys since soon after the summer vacation, and definite cases of diphtheria were
discovered on the 4th November, leading to bacteriological examination on the 14th. The boys harbouring
the bacillus were each injected with 1,000 units of antitoxic serum, and later the remaining
boys, 435 in number, were injected with half this amount. Of the 115 boys, 10 subsequently developed
diphtheria, and of the 435 boys one was subsequently attacked. Subsequent examinations were made
of material from the throats of the 115 boys. On the 28th November, 24 were still harbouring the
bacillus, and subsequent examinations showed that the number thus affected fell to 7, 7, 5, 3, and 1.
In Westminster a number of cases of sore throat occurred among the children attending the French
Protestant school in Noel-street. Dr. Allan gives an interesting account of the outbreak, showing the
number of cases which could be attributed to infection from person to person. The result of bacteriological
examination was to show that the Klebs Loeffler bacillus was harboured by one child, and the
Hoffmann bacillus by another. In Lewisham the infant department of the Plassy-road school was
closed for a few days on account of diphtheria. In Woolwich a number of cases occurred among the
children attending the Wood-street and Gordon schools. In the former exclusion of children on
bacteriological grounds was resorted to. In the latter, the same course was adopted, but eventually the
whole school was closed for two weeks and the infant department for four weeks. In the reports relating
to other districts, similar accounts are given of the occurrence of cases of diphtheria among children
attending particular schools. In Holborn, the infant department of the Rosebery-avenue school was
affected. In Lambeth the Upper Kennington-lane school suffered, and after attempt to deal with the
outbreak by exclusion of particular scholars, the school was closed; prevalence of diphtheria among
the children of the St. Mary's infant school was dealt with by exclusion. In Wandsworth diphtheria
was prevalent among the children of the Brandlehow-road school, and the school had eventually to be
closed There was also prevalence of diphtheria in the children of the Hambro' Orphanage, and the
St. Anne's-hill Home, Wandsworth, both residential institutions. Dr. Caldwell Smith gives an interesting
account of the persistence of the disease in the Hambro" Orphanage. In connection with the outbreak,
among the children of the Brandlehow-road school, Dr. Caldwell Smith states that " a review of the
whole of the circumstances in connection with this outbreak only emphasizes the fact which
has been previously noted, that carrier cases, or cases attending school with the diphtheria bacillus
present, with very few clinical symptoms, invariably cause a serious outbreak of the disease, more especially
it the carrier case or cases attend infants' departments of public schools. One feature of this outbreak.
which has also been previously observed, is the association of the true bacillus and Hoffmann's
bacillus. All the facts which have been observed in this outbreak appear to point to a distinct relationship
between these two bacilli, either they are of the same species, or the Hoffmann bacillus renders
the affected individual more liable to infection by the true bacillus." He thinks, moreover, that the
children were rendered susceptible to infection by a specific germ through the flooding of the basement
of the school, the result of a stoppage of the main drain.
Bacteriological examination of " contacts " is discussed in a few of the reports. Thus, Dr.
Brown has continued in Bermondsey the system which he instituted some years ago. Dr. Davies states
that no " contact " in Woolwich is allowed in return to school except after bacteriological examination,
and Dr. Annis shows in a number of instances in Greenwich the relation of bacillus carriers to certified
cases of diphtheria.
In this connection the London County Council in July adopted the following report and resolution
submitted by their Education Committee :—
" Our attention has been drawn to the difficulties which have arisen in districts where diphtheria
" has been prevalent, consequent upon children who have been excluded from school being certified as
" free from disease by medical practitioners. With a view, therefore, to dealing more thoroughly with
" the disease, the various medical officers of health were asked to adopt the temporary arrangements
" being carried out in Greenwich in the event of there being an outbreak of diphtheria in their respective
" districts. These arrangements involve that any children excluded from school on account of
" diphtheria or sore throat during the prevalence of the disease, should not be re-admitted without a
" certificate from the medical officer of health that they were free from infection.
" As a result of a conference of medical officers of health held on 27th April, 1906, the under"
mentioned resolutions were passed—" That in the opinion of this branch (Incorporated Society of
" Medical Officers) it is not possible in the absence of a bacteriological examination to decide that a child
" is free from the infection of diphtheria. In the event of the prevalence of diphtheria in any district
" any child excluded for sore throat should not be re-admitted to school without a medical certificate
" of freedom from infection, based on a bacteriological examination."
" We are of opinion that it would greatly strengthen the hands of the various medical officers,
" and do much to reduce the present risks of infection, if authority were given for the refusal, during
" the presence of diphtheria in any district, of the re-admission of children excluded from school as