View report page

123
school nurses for the purpose of keeping the children under careful supervision and
swabbing where necessary. In certain of these schools the attention of the school
nurses was confined to the selection of suitable cases for swabbing and to advising
the head teachers as to exclusion or re-admission of the children. In the heavily
infected districts, however, a more intensive scheme was put into force and no child
who had been absent from school was allowed to resume attendance until proof had
been obtained by bacteriological examination of freedom from infection of diphtheria.
The schools were visited daily until the situation had improved and afterwards at
fairly frequent intervals until the outbreaks had ceased. At the beginning of 1927,
9 schools (17 departments) were still being visited daily and the more intensive
scheme was being applied in 4 schools (7 departments).
Many of the school nurses have attained high proficiency in the technique of
swabbing, and their work in dealing with diphtheria outbreaks has been of very
great value. In one school alone (Tennyson Street school, Battersea) where between
September, 1926, and the first week in February, 1927,52 cases of diphtheria occurred,
35 in the infants' department, 10 in the boys' and 7 in the girls' department, the
school nurse swabbed some 800 persons, including school children, children under
school age and in some cases the parents, and discovered 54 harbouring diphtheria
bacilli; of these 35 were notified, mainly at the instance of the medical officer of
health of the boroughs concerned and removed to hospital, although only one showed
any clinical signs of diphtheria. The policy of notifying diphtheria carriers is of
very doubtful value save in special cases, as for example, those occurring in residential
institutions, and is discouraged by the Ministry of Health, for not only does
it seem unwise to treat a physically healthy child in a fever hospital, but the effect
upon the local inhabitants, who cannot be expected to distinguish between a clinical
and a purely "bacteriological" case, tends to create undue panic; also the notification
of such cases vitiates the statistical records and makes for artificially
inflated epidemics. Furthermore, a diphtheria carrier being already immune to
the disease will not develop clinical diphtheria.
By way of further illustration, it may be mentioned that at another school
(Keeton's Road school, Bermondsey), 58 cases of diphtheria occurred between
September, 1926, and January, 1927, and similar action by the school medical
service was taken as in the case of Tennyson Street school. Following upon a sudden
outburst of 23 cases which were notified from the infants' department immediately
after the mid-term holiday, Dr. Boome visited the school from time to time, and
his inspections were supplemented by daily visits by the school nurse. In all,
23 children were found to be harbouring diphtheria germs, only 5 of whom were
notified and removed to hospital. Following upon the vigorous action taken,
the outbreak was reduced to a few sporadic cases between the middle of November
and the Christmas holidays. The parents were kept informed of the action taken
at the school, and by a judiciously worded circular sent out by the infants' head
teacher, panic was allayed. There is no doubt that by the stringent supervision
maintained and by securing the confidence and co-operation of the parents a more
serious extension of the disease was averted.
For reasons of space it is not possible to give a detailed account of the outbreaks
at individual schools and the methods employed in combating the spread
of infection, but experience has shown that where a nurse can be spared to visit the
school daily and ensure the exclusion from school of all children who are likely to
be foci of infection, the spread of diphtheria in the face of a threatening outbreak
can be controlled with a considerable measure of success.
There was a slight increase in the prevalence of scarlet fever among children
attending the Council's schools, 5,872 cases having been reported, as compared
with 5,717 in 1925. Figures for the preceding three years will be found in the
table on page 58. The disease was most in evidence during the spring and winter
Scarlet
fever.