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Report of the Medical Officer (Education).
165
be made more natural and speech more automatic. The absence of a properly worked out scientific
classification of deaf children is another hindrance, but not as important as the neglect of the plastic
period of speech development.
On the 10th October, 1910, the occurrence of a series of cases of appendicitis came under
observation on the report of the managing committee of the Mayford Industrial School.
On the 16th September, S. Y. (1876) was taken ill with definite symptoms which
within 24 hours became those of general septic peritonitis. Immediate operation was performed,
a loose and gangrenous appendix being found, and the boy dying next day.
Three other cases were recognised very early with mild symptoms, and were immediately
operated on with good results. In each case inflammatory bands and signs of old appendicitis
were noted. The boys and dates of operation were J. H. (1897), September 18th ; T. S. (1906),
October 5th ; and A. F. (1897), October 7th.
Appendicitis
at Mayford
Industrial
School.
Enquiry was made and certain improvements suggested in the school arrangements, but no
definite reason for the rapid sequence of cases could be assigned beyond the fact that careful observation
of abdominal symptoms had been kept up after the first alarming case. Of the 13 boys admitted
to the school during the year 4 were so delicate that it was suggested longer hours of rest and sleep,
shorter hours of educational and manual work, and a lighter diet would be desirable. Application was
ultimately made to the Home Office under Section 53 of the Children Act to board out these four boys.
By the end of the year three more mild cases had been operated on, but further action was deemed
unnecessary. As, however, three further cases had occurred by the 19th January, an exhaustive
enquiry was commenced at the school by Dr. C. J. Thomas, and Professor G. F. Still, of King's
College Hospital, was invited by the Council to investigate and report on the whole matter. An outbreak
of sickness occurred in 13 boys on the 22nd and 23rd January, 1911, and one of these boys was
operated on on the 26th January, making a total of ton cases of appendicitis needing operative
interference. Careful consideration of the individual cases showed that except in the fatal case
there was definite evidence of old standing inflammation of the vermiform appendix. The problem
was not one of appendicitis in previously healthy boys but of a series of recurrent attacks. Any
question of infection or contagion could therefore be set aside. This is borne out by the spacing of the
attacks in time, and by the conditions found on operation. It must be remembered that many
attacks of pains and stomachache in children are manifestations of appendix trouble, and it seems
a possibility that the alarm of the first fatal case and the consequent expectancy and anxiety of the
officials resulted in even the slightest attacks being detected. This must not be taken as an adverse
criticism of the treatment, for in light of the first case once the diagnosis was established any other
treatment would have been unjustifiable. It was well for these boys to be operated on and freed
from a condition which presented a constant menace to life. Attacks could not be traced to the
dietary, but the stores were put out of use till all the materials had been analysed. Some of the
materials were found to be not of the purity or standard arranged for, the sugar for instance was
tinted with an aniline yellow. The milk was unexceptional, although one cow when tested was found
to be tuberculous and has been removed. The water, although hard, is pure. Some of the boys
were found to have eaten vegetables and fruits immoderately in the fields ; two, indeed, had gorged with
blackberries immediately before the attack, and two had gorged themselves at table by swallowing their
neighbour's porridge or soup in addition to their own share. The conclusions were that food irritatation
was the probable cause of the recurrences, although the particular irritant could not, in all cases,
be determined. The material removed by operation in the two last cases was thoroughly tested by
the Clinical Research Association and a Gaertner-like bacillus which was isolated from one of the
cases was used for agglutination tests. Three boys who had been sick on the 22nd January, three
boys who had not been sick then but who had been operated on for appendicitis, and three boys
who had remained in good health were tested, but the reactions were generally negative or inconclusive.
Summarising the facts, the occurrence of such a series of cases is almost inexplicable. Except
the first case, the symptoms were generally mild, and excepting in this case Dr. Lawrie found in all the
results of old-standing appendicitis. The attacks appear, therefore, to have been recurrences and
no infection or any common cause could be traced. Food irritation due to irregular feeding on
indigestible material in the fields often indulged in by healthy country boys may have acted as an
irritant in these boys previously disposed to attacks of appendicitis. There have been no further cases
during the first quarter of 1911.
Following up the experience of the previous year, playground classes were again instituted,
are of various characters, distinguished as follows:—
These Playground
Classes.
A.—Classes of delicate boys of equal educational standing chosen from neighbouring
schools by the school doctors.
B.—Classes of delicate girls of varying educational standing selected (but not by the school
doctor) from one school.
C.—Classes of children in the same standard of one school only, the same class being
taken out each day of the week.
D.—The various standards in the school are taken in the playground in rotation.
It has now been decided that five playground classes of type A, one class of type B, and 50
classes of type C and D (as many as possible of type D) shall be held during the year 1911.
The classes of type A (central classes) were held at "The Lawrence," Daniel-street, Turinstreet,
and Cator-street. The selection of children aged between 9 and 13 was by the school
doctors, who made a choice from the contributory schools of such weakly or debilitated children