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44
[???]fluenza.
The widespread epidemic of influenza which visited this country during 1918 occurred
in two distinct epidemic waves, viz.. June-July and October-December, followed by a third wave early
in 1919. Similar widespread epidemics of the disease were reported in this country in 1803, 1833,
1837-8, 1847-8, and 1889-92. It is difficult to say how far the epidemics of the last twelve months
were influenced by the special conditions arising out of the war, but increased traffic, closer aggregation
of persons, and the movements of population, both civil and military, no doubt contributed in assisting
spread of the disease. It is significant in this connection that the population of London, which was
largely increased and seriously congested as a result of the war, suffered a higher death rate from
influenza on the average during the autumn epidemic than the remainder of the large towns in England.
Already early in 1918 attention had been arrested by the occurrence of a series of fatal cases
of pneumonia in a reformatory school, and it became quite clear later, when the prevalence of
"epidemic lethargy" was noted in April, that a special epidemic influence was at work. The first
intimation of the presence of "influenza" in London in epidemic form was on the 15th June, 1918,
when sudden explosive outbreaks of illness were reported to have occurred in certain factories, one
situated in Finsbury and the other in Chiswick; a similar outbreak was reported among the staff of
one of the Customs and Excise Offices. The two first-named outbreaks were investigated by
the Council's medical staff, and it was found that the symptoms complained of closely resembled
those met with in previous epidemics of influenza.
Following upon these outbreaks reports were received from schools in various parts of
the county which demonstrated conclusively that the epidemic was established in London. The
average attendance at many of the schools was reduced in the next few weeks by as much as 30 per
cent. and more in some cases. The teaching staff were also attacked in considerable numbers and in one
or two instances, schools were forced to close owing to lack of staff. The question of closing the schools
as a preventive measure was carefully considered, particularly as this course was being adopted in
certain other parts of the country, but the conclusion was arrived at that, in view of the widespread
nature of the epidemic, and the numerous opportunities of contracting infection from outside sources,
school closure would serve no useful purpose as a preventive measure. Head teachers were enjoined
to pay special attention to free and continuous ventilation of classrooms, to prohibit unnecessary
grouping of the children, and to send home at once all ailing children. Appropriate notices were issued
in the London County Council Gazette with these objects in view.
In illustration of the difficulties experienced in particular instances, the outbreak of illness among
children on a "school journey" may be referred to Thirty-six girls and three teachers left London on
the 3rd July and joined four girls, belonging to a previous party, in a village some dozen miles away.
In all, nine children became acutely ill, seven with undoubted influenza; two others were believed to
have had scarlet fever. It became necessary to improvise arrangements for the treatment of the children
away from their homes and thanks to the energy shown by the teachers and the medical help available
locally, the emergency was successfully met.
The first epidemic wave in the summer did not approach in virulence the second epidemic wave,
which commenced in October and reached its culminating point about the end of October and the
early part of November. The heavy death toll exacted during the autumn and winter was to a large
extent attributable to complications due to secondary infections, mainly pneumonia.
[???]sles and
[???]man
[???]sles.
I he total number of cases of measles and German measles reported as occurring among school
children during 1918 was 25,880, as compared with 45,000 (uncorrected) first cases occurring in families
notified in accordance with the Public Health (Measles and German Measles) Regulations, 1915.
During the year one classroom was closed for a short period, and unprotected children were temporarily
excluded from 780 classrooms, whilst in 9 schools all children under 5 years of age were excluded for
appropriate periods.
[???]ooping
[???]gh.
The number of cases of whooping cough reported as occurring among school children was higher
than usual, viz., 11,671, as compared with 7,117, 8,595, 10,959, 9,977 and 9,762, during the years 1917,
1916, 1915, 1914, 1913 respectively. Whooping cough was compulsorily notifiable in Greenwich,
Lambeth and Holborn.
[???]gworm
Favus.
There has been a marked decline in the number of cases of ringworm occurring among school
children during the past few years, mainly due to the successful results of X-ray treatment and to the
strict control exercised by the school medical and nursing service. In 1911 there were 6,214 fresh cases
of ringworm reported from the schools but in 1918 the number of cases had diminished to 2,639. During
the year 2,555 cures were effected, of which 51 per cent. were by means of X-rays. At the end of the
year only 979 school children were known to be still suffering from the disease. The number of hair
specimens submitted by school nurses for microscopical examination was 1,945, of which 1,026 were
found to contain ringworm fungus and 9 showed the presence of favus.
Only six fresh cases of favus were reported during the year.
The standard of health so far as infectious diseases, such as scarlet fever, diphtheria, measles
etc., is concerned in residential, special and industrial schools and places of detention, has been satisfactory.
On occasions when such ailments have been introduced preventive measures have been
taken and outbreaks have been averted. In common with the rest of the population, influenza attacked
several of the institutions during the epidemic, but on the whole it may be said that the Council s
residential schools and places of detention were less affected in proportion than the elementary schools
and many other classes of the community.
[???]let
[???]er and
[???]theria.
These two epidemic diseases have fortunately during the last few years been at a low ebb. Tiltimportance
of this fact has, as noted in previous reports, been great, inasmuch as the claims made upon
hospital accommodation for isolation purposes have in consequence been comparatively limited and