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12
It is a well-known fact that defective drainage and Diphtheria
outbreaks bear some definite relation to each other, since in a large
proportion of households invaded by Diphtheria throughout the
country, drainage defects are found to exist, indeed in our District
such has been the case. In the great majority of infected houses
minor sanitary defects have required attention.
Reporting in November on a group of 15 cases—the majority of
patients being Scholars at the North Road Schools, I concluded that
the Schools formed the centre of infection.
I visited both schools on the 4th of that month and examined
all Scholars present.
I found one child present in School in the early stage of the
disease, and she was removed to the Joint Isolation Hospital the
following day: and although this was the only case of Diphtheria, I
found a large percentage of children in both Schools had enlarged
glands in the neck, (29 per cent. in the Mixed Schools, 40 per cent.
in the Infants) Such enlarged glands proceeding as they often do
from previous sore throat—amongst other causes—often indicate
"weakness" of the throat, and this renders a child much more liable
to take an Infectious disease like Diphtheria.
I considered it my duty under these circumstances to certify that
the closure of the Schools was necessary.
This was thought by some to be a very drastic measure, but it
appeared to me to be the only course to take for the suppression of the
epidemic. I felt little doubt that the continuance of the disease was
due to the attendance at School of mild unrecognised cases of the
disease.
It is now well known that a child in good health may carry about
in his throat the microbe of Diphtheria, and though this carrier of the
microbe may himself resist the attack of the germs a susceptible child
receiving it from him may contract a fatal illness.
Again, as to drinking utensils provided for the children, I found
only one was in use at the Infant School, and two at the Mixed
Schools.
Since these iron vessels cannot be efficiently cleansed before use,
they appeared to me to be a very probable means of conveying infection.
A child suffering from a mild attack and drinking from one of
these vessels may easily leave thereon a sufficient number of Bacilli to
infect another child.
It has been argued that School closure cannot be a very efficient
measure in suppressing an epidemic such as Diphtheria, as the children
when not at school are liable to meet in the streets or each others
houses for play.
But it is clear that infection is less likely to be imparted in a
wholesale manner under these conditions than it is at school where