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198
Annual Report of the London County Council, 1913.
The children in the infected department were examined on 1st October and 2nd December, and
some of them were found to be harbouring diphtheria bacilli. The boys' department was not affected.
This school was systematically kept under observation by school doctors and frequent periodical visits
were made. On each occasion suspicious cases were examined with a view to detecting carrier cases.
In all 96 swabs were taken and 10 children proved to be harbouring diphtheria bacilli, and a further
14 showed the presence of bacilli which could not be differentiated from the true Klebs-Loeffler bacilli.
No reason could at first be ascribed for the outbreak, but on 6th December two boys attending
the same classroom in the infants were discovered to be carriers and were excluded. The Sunday school
and other places frequented by children of this school were closed, and other precautions were carried
out to prevent spread of the disease.
The chronic intermittent carrier of diphtheria germs, R.C., referred to in full in the report for
1912, is still in one of the Metropolitan Asylums Board hospitals, where she was admitted on June 12th,
1912. She has been under very careful observation and now looks very well, and has grown quite
sturdy. A number of methods of treatment for the elimination of the Klebs-Loeffler bacillus from the
child's throat and nose have been tried, but cultures from her throat still exhibit the diphtheria bacilli,
which on several occasions have proved virulent or partially so. The methods tried have been,
segregation with thorough feeding and regular hygiene of nose and throat; inoculation with an
autogenous vaccine of 24 hours' growth ; spraying and swabbing with various antiseptics; spraying
and swabbing with broth cultures of staphyloccus pyogenes aureus ; and, lastly, swabbing and spraying
with protargol, a silver compound, so strongly recommended in carrier cases of cerebrospinal fever.
The complete enucleation of the tonsils and removal of adenoids have been found efficacious in many
cases. R.C. has not much tonsillar tissue, but it would appear to be worth while to remove this, and
the consent of her parents is being sought for this purpose.
The facilities afforded by the existence of a laboratory as part of the Public Health organisation
have proved to be of very great value in arriving at an accurate diagnosis as to the cause of
illness of scholars, both in cases of sore throat associated with infectious diseases, and in the
diagnosis of doubtful cases of ringworm and favus and other microbic infections. It has consequently
been of very great assistance in the detection of possible foci of infection in the Council's schools. In
addition to the work in connection with elementary and secondary school children specimens are frequently
received from the Council's places of detention and industrial schools for bacteriological examination.
In the following table the number of specimens examined for diphtheria, together with results of the
tests, are classified in the respective administrative divisions.

Particulars of the work done in connection with ringworm will be found on page 105. A certain
number of miscellaneous microscopical examinations have been made, for example, specimens of materia
for examination have been submitted from time to time in connection with the administration of the
Midwives Act, and the Council's midwifery classes at evening continuation schools; in other cases
contagious diseases of uncertain origin have been investigated among school children by means of a
microscopical test.
The actual and potential advantages of a well equipped laboratory can scarcely be over
estimated as a unit in the administrative machinery of the school medical officer, and it is hoped that
the possibilities thus opened up may prove of increasing value as a means of controlling infectious
diseases.
Measles.
During 1913 there was a noteworthy .decrease in the incidence oi measles, lhe number of
cases notified amounted only to 15,112, which is considerably lower than the figure for any of the
seven preceding years as shown in the above table. During the autumn and winter months there
was a period of unusual quiescence. The following figures give the incidence of measles in each
quarter of the year:—
Number of Cases.
January-March 7,277
April-June 4,813 .
July-September (including summer holidays) 2,445
October-December 577
Total 15,112
It will be seen from the above table that measles was most prevalent in the first quarter of
the year, and that the incidence gradually diminished until the end of the summer months, after
which there was a considerable drop, the number of cases in the last quarter being extraordinarily
few.