[Report 1904] / Medical Officer of Health, Salop / Shropshire County Council.

  • Shropshire Council
Date:
1904
Catalogue details

Licence: Attribution 4.0 International (CC BY 4.0)

Credit: [Report 1904] / Medical Officer of Health, Salop / Shropshire County Council. Source: Wellcome Collection.

    26/100 (page 14)
    I hold very strongly that it ought not now to be necessary to close schools for diphtheria if the proper means at our disposal he applied. In this connection I quote Dr. Thomas, one of the Medical OHicers to the London Sclioul Board : ‘’ It has been shown that school closure ought seldom or ne\-er to be necessary in elementary schools owing to the prevalence of diphtheria. With modern technique it is i)ossible to discover those who are sj)reading the disease and obtain their exclusion. The objections to school closure are that the ■' carriers ’ are not discovered and isolated and that there is not the least guarantee that at the end of the period of closure the children who are the cause of the spread of the disease will be innocuous. The closing of schools for dii)htheria should be looked upon as a confession of impotence and defeat.” Diphtheria is spread in schools by children who have diphtheria bacilli in their throats but have not suffered from the disease (called ‘carriers'), b\ children who have suffered from diphtheria in a mild and undiagnosed form, and by children who have been known to have been suffering from diphtheria but have returned to school whilst srill infectious. To deal with these latter cases I have recommended to the Education Authority that no children who have had diphtheria be allowed to return to school until their throats have been declared free from diphtheria bacilli. The undiag¬ nosed cases and the carriers should be dealt with in the following manner. Whenever there is anv indication of school infection by the occurrence of two or more cases in one class within a period that points to a common source, this class should have special attention, and a bacteriological examination should be made of the throats of those children who ap])ear likely to have spread the disease. In some cases it may be necessary to examine all the children of the class, but in the majority of instances it will probably suffice to examine (i) all children who have been absent during a certain j^eriod from unexplained causes or minor ailments; (2) children with discharge from the nose or ears or suffering from other conditions not infrequently left by diphtheria; (3) children who habitually breathe through their nlouths ; and (4) children who are known to have been in contact with a case of diphtheria. The experience of this method in London during the period August, 1903, to March, 1904. is that the disease was always arrested without the closure of a school. Typhoid or Enteric Fever.—There were 50 cases and 9 deaths, compared with 53 cases and 6 deaths in 1903. No district was at all seriously affected except Wenlock, in which there were 14 cases, and to a less extent Oakengates, in which there were six. Speaking of the outbreak in Wenlock Dr Gepp says : “Of the eight houses infected, seven were in Madeley Ward, and five of these were on the river side. In two of these the river water was used for all purposes and drunk, in two others the river water was carried in for washing purposes and mig’nt have been drunk. In the fifth the river water was said not to be used. Of the remaining two outbreaks in Madeley Ward, in one the patient was a child in the habit of visting regularly a house on the river side where river water was brought in for washing purposes, and in the other case drinking water was had from a pumj) in insanitary surroundings. I have no doubt at all that the use of polluted river water was responsible for at least four of these outbreaks, and possibly for more, and the close connection of jiractically all with possibilities of bad water is instructive and one is led to hope that the use of river water in the district, and of water from pumps in unwholesome surroundings, will rapidlv diminish and die out.” Six cases occurred in one house, spread probably by jiersonal infection. Two cases in Clun Rural District and one in Newport L'rban District were associated with an impure water supply. Three of the six cases in Oakengates were attributed to defective drainage. The origin of the nine cases in Shrewsbury was obscure and the same remark might be applied to a considerable proportion of the ca.ses throughout the county. None of the cases were referred to the consumption of infected milk or shellfish.