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xiii.
would result from instruction given to the teachers in special watching of
doubtful cases, and selection by them of suspicious children for special
examination by the School doctor.
Diphtheria. Diphtheria is certainly the most serious of the four diseases
I am considering, but at the same time it is the only one that can be attacked in
a clear and scientific manner, with a well founded hope of success. I have no
doubt whatever that the appointment of a Medical Officer to the Schools would
be more than justified if his sole work was in connection with this disease. I
need not enlarge on the danger and heavy mortality it causes; that is known to
everybody. But I would remind you that during the past few months the
number of cases in this district has been considerably above the average, and
most of the patients have been children attending the public Elementary Schools.
Practically every School has had cases, some many, others only one or two.
The number of cases has not reached what might be called an epidemic, and
though they have been a source of considerable anxiety to me, at no time has
the total arising in any one particular School been sufficient to justify the special
and drastic measures that, as Medical Officer of Health, are the only ones I
have power to employ. As you know, practically all that a Medical Officer of
Health can do under his present powers to deal with an outbreak of infectious
disease in a School, is to close that School, and thereby deprive all the children
attending it of teaching for an indefinite time. Closing a School is for this and
other reasons, in my opinion, quite unjustifiable, except under very exceptional
circumstances. It is a confession of weakness and lack of energy, for it only
tends to hide the symptons without attacking and removing the cause.
Careful investigation during the past few months has failed to reveal any
common source of infection in any of the Schools in which cases of Diphtheria
have arisen. Very seldom has more than one secondary case been traced to a
primary one. As a matter of course and ordinary routine practice, whenever a
case of Diphtheria has been notified, any other children in the same house
or family have been excluded from School till after the normal period of incubation
has passed, but nevertheless other cases have occurred in that Schcol at
odd intervals.
The usual inquiries that are always made by the Sanitary Inspectors in all
cases of infectious disease notified, have, only in a very few instances, shown any