View report page

148
Annual Report of the London County Council, 1912.
cases were known to have occurred in this school. All of them came from two class-rooms in the mixed
department, the majority from room 5.
Arrangements had been made for the school to be visited on the morning of December 5. At this
visit all the children in the affected classes were examined, and suspicious throats were swabbed for
bacteriological examination; those absent at the visit were excluded, pending inquiry at their homes by
the Medical Officer of Health. The dates of last attendance of the notified cases were as follows:—
One case November 28
Five cases „ 29
One case „ 30
Four cases December 1
Two cases „ 5
Two cases „ 8
Five cases „ 21
Subsequent inquiries pointed to a certain child who, though ill on November 27, continued to
attend school until the afternoon of November 29. During these two days he had been attending
lessons in two rooms (Nos. 5 and 7), and he may have been responsible for most of the cases in these
two rooms. Fifteen children from a neighbouring orphanage attended school until December 1; on
this date one of them failed with diphtheria, and the remainder were kept at home; of these, three
others failed with diphtheria during the next few days.
Teachers were instructed to segregate the classes and to keep a strict watch for suspicious illness,
and the two affected classes were closed from December 5 to December 11. The school was kept
under observation and six visits made to detect bacteriological carriers. The infants' school subsequently
also became affected. In the two departments 70 children were tested bacteriologically, and of
the 89 tests made 13 showed the presence of the Klebs-Loeffler bacillus.
Two carriers Were subsequently discovered. One is of special interest as he was apparently
examined at a period when not showing evidence of bacilli and he was allowed to return to school. The
following summary gives the important facts of the case: C. C., aged 12. Throat unhealthy on December
5; culture showed Klebs-Loeffler bacillus. December 13: Certificate produced—freedom from
infection based on bacteriological grounds—teacher re-admitted him. December 19: Medical officer
visited school and attention was drawn to this boy. He had no discharge from the nose, but only crusts;
boy picked his nose and there was a tendency to bleeding. Bacteriological examination now gave KlebsLoeffler
bacillus in both throat and nose ; he was again excluded. On testing Klebs-Loeffler bacillus
from this growth it gave the glucose broth reaction and it was slightly virulent. Klebs-Loeffler
bacillus was isolated on five subsequent occasions. Those bacilli isolated on January 25 were re-tested;
the result was a positive sugar broth reaction, but no virulence. He was allowed to remain at school
but kept under close observation until April. During this time the nasal crusts had disappeared, and
though the tonsils were enlarged there was no inflammation. Klebs-Loeffler bacilli were found until
March, but by April they had apparently disappeared.
(IV) Lavender-hill School.—This outbreak was at first limited to one class-room, attended by
boys who had recently been transferred from the infants' school. The corresponding girls and the
infants remained free. The outbreak was possibly attributable to a boy who was re-admitted by a
misunderstanding on the part of the teacher, and later again on a bacteriological certificate. He was
found to be a carrier. There were in all five notified cases with one death and 16 bacteriological
cases in a class of 60 boys (26 per cent). The class was visited on nine occasions. At the fifth visit
every boy in the class was swabbed, and amongst the apparently healthy children five Klebs-Loeffler
bacillus carriers (8 per cent.) were detected.
The history of the unrecognised case is as follows: C. B., aged 9, was absent from January 20
to February 19 with "chill and bad cold." On February 19 he was re-admitted on producing a certificate
which read, "No signs of diphtheria, bacteriological examination unnecessary." February 23: Reexcluded
on advice of a school doctor. February 26: Re-admitted on certificate, which stated "No
Klebs-Loeffler bacilli present." As further cases continued to occur in this class-room, C. B. was retested
on March 20 and found to be harbouring Klebs-Loeffler bacilli. He was excluded and remained
out of school until May 24.
The history of some carrier cases suggests that the infection not only may be of long
standing, but may also be intermittent in character. The following is a case in point.
As cases of diphtheria continued to occur in Kilburn-lane school, teachers were advised to
exclude all cases of sore throat or suspicious illness. A boy, T. R., aged 13, was excluded on January 19
with "swollen tonsils." February 13: Medical Officer of Health took a culture; result, Hoffmann's
bacilli. February 24: Medical Officer of Health took a culture ; result, Klebs-Loeffler bacilli; parents
advised to get the boy's throat treated. March 8: Klebs-Loeffler bacilli still present. March 27:
Hoffmann's bacilli only found; no treatment obtained; parents again advised. April 10: Klebs-Loeffler
bacilli found, and child notified as bacteriological case. April 12: Removed to hospital. April 25;
Discharged from hospital with certificate "not diphtheria." May 20: Medical Officer of Health finds
Klebs-Loeffler bacilli; tonsils still enlarged; no treatment yet obtained; Medical Officer of Health
desires exclusion of other children from home. June 7: Parents not only refuse treatment, but apply
for re-admission of children to school asserting that the boy had no diphtheria when discharged from
hospital. June 10 : Father writes complaining of the exclusion from school of his children and demanding
immediate readmission. Refuses treatment. June 17: T. R. "swabbed" by school doctor: KlebsLoeffler
bacilli found ; parents advised to seek treatment, June 26; Boy again " swabbed " ; Kleba-