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(a) the son had been absent from his school in the City on the 19th and 20th January with diarrhoea;
(b) the mother had a similar illness on the 26th January; and (c) the father had had
severe attacks of diarrhoea on the 31st January necessitating medical attention.
Specimens of faeces from the three were examined by the Pathological Department of St.
Bartholomew's Hospital, and cultures from those of the mother and son yielded growths of
Shigella Sonnei. Sensitivity tests on the Shigella Sonnei indicated that it was only moderately
sensitive to Tetracycline and Sulphonamide, but was full sensitive to Streptomycin, Chloramphenicol
and Neomycin. This information was conveyed to the medical practitioner concerned to
assist him in the treatment of the complaint.
Enquiries made at the School revealed that since the middle of January some 60 children had
a history of illness which could be associated with Sonnei Dysentery. Since the greater number
of these live outside the City, and to exclude the possibility that the first child was an isolated
case, it was decided to enquire first into the cases of the eight children living in the City before
general remedial measures were instituted.
Specimens of faeces from the City children were examined when it was discovered that there
were other cases of the disease. From this further evidence it was concluded that an outbreak
of dysentery existed at the School. Remedial measures covering the whole School were then put
into operation. These measures may be summarized as follows
(1) Medical Officers of Health of all the districts where the suspected cases lived were
notified of the circumstances.
(2) A communication was addressed to all the parents of children attending the School. A
copy of this letter follows
"As Medical Officer of Health for the City of London I have been informed that a number
of cases of dysentery have occurred among the children attending the above-named School.
"There is no cause for undue alarm since the type of dysentery usually met with in
schools is rarely a serious danger to health, but the disease is capable of causing enforced
absences from school and a serious dislocation of school life.
"Your co-operation is sought to assist in checking the spread of the disease. Parents
are not immune from infection and instances have occurred where they have contracted the
infection from children.
"PREVENTION. Dysentery is spread by fingers or other things used in common
which have become infected by contact with faeces. The following precautions will make a
serious outbreak of the disease less likely to occur:—
(a) The most important single thing that can be done is to ensure that children wash their
hands thoroughly after using the water closet; the use of common towels should be
avoided and, if practicable, paper towels only should be used.
(b) W.C. seats, pulls, toilet paper holders, door handles and the surrounding walls and door
are most likely to be contaminated — they must be kept clean, and the W.C. seat could
be swabbed after use with a dilute disinfectant.
(c) Toilet paper must always be available in the water closet.
(d) Before meals, hands should be thoroughly washed.
(e) It would be of advantage if children could be persuaded to attend to the wants of nature
before leaving home. This would result in a less demand being made on the sanitary accommodation
provided at the school with a less risk of contracting the disease.
(f) Anyone, parent or child, who has had symptoms of dysentery, i.e. diarrhoea (loose
stools which contained slime or blood and slime) within the last six weeks should be
seen by his/her own doctor with the explanation that they may have been in contact with
cases of the dysentery germ known as "Shigella Sonnei". For the information of your
doctor the Shigella Sonnei implicated has been found to be only moderately sensitive to
tetracycline and sulphonamide, but is fully sensitive to streptomycin, chloramphenicol
and neomycin.
"I am sure you will do all you can to assist the Headmaster and the Teaching Staff in
the efforts being made at the School to prevent further cases occurring among the children
who attend the School.
(3) An inspection of the School premises indicated that the sanitary accommodation was
ample and in a clean condition. The main criticism was the absence of hot water for
washing, and roller towels used in common by the children. These towels were replaced
by paper towels, and wire baskets provided for the collection and burning of the used
towels. The School Authorities were communicated with indicating the urgent need for a
supply of hot water over all lavatory basins.
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