London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1912

[Report of the Medical Officer of Health for London County Council]

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Annual Report of the London County Council, 1912.

Table B

Age distributionYears.
Total population4,708794348460390465816498488255194
Total diphtheria cases159837817352735109
Percentage incidence% 3.3% 1% 0.8% 1.5% 2% 3.6% 4.2% 5.4% 7.2% 3.9% 4.5

of scarlet
fever and
in certain
The cases of the six schools above referred to, illustrate unusual diphtheria prevalence. Study
has been made of the extent to which both scarlet fever and diphtheria sometimes persist in schools.
The accompanying Diagram C shows the distribution of cases of both diseases week by week for three
consecutive years, in 30 selected schools. Examination was made of the scarlet fever record of all the
large Schools (over 1,000 on the roll) and the 30 schools with the highest and the 30 with the lowest
incidence of scarlet fever in 1912 were selected. From each group of 30 Schools, 15 were chosen as being
those which during the period 1910-12 showed the highest and lowest incidence of the two diseases
taken together. The cases for each of the 30 schools were then plotted out in weekly periods. In the
diagram each horizontal line represents a school, the scarlet fever cases are shown above, and the
diphtheria cases below this line. Study of the diagram shows clearly the tendency in some instances
for both scarlet fever and diphtheria to persist when once a school has been definitely involved. This
fact is one familiar to those who have studied records of disease distribution in schools. Dr. Niven,
Medical Officer of Health of Manchester, referred to it nearly 20 years ago (see particularly his Annual
Reports, 1897-1901). He speaks of "the tenacity of the disease scarlet fever) as regards particular
departments." He says "It may go on for a year or more in a department, attacking a case in May,
another in June, another in July, and so on." The evidence afforded by the diagram now under consideration
goes to show that this process of repeated attack continues not only for months but for
years. This subject of occasional persistence of infection in classrooms was referred to in the Annual
Report of the Medical Officer of Health of the County of London of last year, p. 63, to which reference
may be made in this connection.
Another point to be observed is the close association of the two diseases scarlet fever and
diphtheria. Thus, in the schools in which there is heavy incidence of scarlet fever the incidence of
diphtheria is often well marked also. For instance, school No. 1 had by far the greater number of
scarlet fever cases in the three years under observation and it also suffered to a notable extent from
diphtheria, more especially when scarlet fever was at its period of maximum prevalence in the latter
end of 1911 and the beginning of 1912. Similarly in school No. 2, where diphtheria was especially
prevalent, the period of maximum incidence was preceded by a crop of scarlet fever cases which continued
also to occur throughout the period of maximum diphtheria prevalence. It is important to
note that the persistence of the two diseases in the affected schools was maintained in Spite of the
careful exercise of precautionary measures, and these included, in the case of diphtheria, the carrying out
of bacteriological examinations and the rigid exclusion of all children found to present evidence of
acting as carriers of diphtheria bacilli. The facts certainly seem to indicate that the subject of the
association of scarlet fever and diphtheria is deserving of further study.
It will be noted in the Table on p. 27 that there has been during the year a very considerable
diminution in the prevalence of measles, 19,809 cases having been reported as compared with 31,905
the preceding year, whilst 761 schools have been under special observation. This reduced incidence
has followed in natural sequence upon the extensive epidemic of 1910-11 which largely reduced the proportion
of susceptible children. The mortality of all persons due to measles presents a corresponding
reduction, there having been 1,799 deaths from measles during the year as compared with 2,570 in 1911.
The usual seasonal influences were experienced in the spring and autumn, the spring outbreak having
reached its culminating point in the early part of June, whereas the autumnal prevalence was felt chiefly
during November.
When measles has been introduced into an infants' department of a school immediate steps are
taken to prevent the unprotected children from attending school during the fall of the second crop,
and special attention is focussed upon the children under five years of age among whom the mortality
is chiefly felt.
During the year large numbers of unprotected children were excluded for protective purposes
and particulars of these exclusions are to be found in the table on p. 38.
In addition to direct action taken at the school as regards exclusion of unprotected children,
head teachers are consistently advised, apart from the general rules laid down in the prescribed regulations,
to take the utmost precautions in promptly excluding suspects, exercising a strict surveillance
over the children, preventing as far as possible all mixing and massing of the classes, and generally
assisting in minimising the risk of dissemination of infection. In addition, the parents of susceptible
children in affected classrooms are warned of the occurrence of measles at the school by means of a
card upon which appropriate advice is given.
The charts in diagram D show respectively the average weekly deaths from measles in London
for the 34 years before and the 39 years after the year 1874.