SCHOOL EPIDEMICS

1237 has been the success of the preparatory schools in achieving perfect health conditions. The public schools might well complain that the efforts and precautions of many of the preparatory schools have been too successful. Boys and girls go on to the big- schools in a state of epidemiological innocence and with little preparation for guerilla warfare with microbial infection. The public schools have thus to bear the brunt not only of epidemics of their own age-group but of others which, if they must be faced, might well have been faced earlier. It is not uncommon for a boy or girl to catch measles, whooping-cough, and scarlet fever in addition to minor infectious complaints during the three or four years at public school, and even if the scholar passes through these without giving personal cause for anxiety the parent may become restive at the loss of school time due to the interference in routine which must accompany epidemics. Artificial immunisation has little to offer. Its modern triumph is against diphtheria, a disease rarely met with in better class schools. The public hears vaguely that scarlet fever and measles can now be prevented or aborted, and though this is true it would be well-nigh impossible to apply the new methods to school life. The only solution of general application is the one attempted in all well-managed schools-to keep the individual boy or girl in the best possible state of health and to make every effort to prevent threatened epidemics from gathering headway. Infection being accepted as inevitable, the child encounters it in the best possible position to overcome it with his own defences. We hope it may not be taken as a counsel of despair if we suggest that until the study of infection has reached a more advanced stage it would be well for the parent (even if he is a doctor) to look upon the public schools, with his grandfather’s eyes, as a place where a boy can learn to make his first trials against the struggles and hardships of life, not forgetting that this applies as much to the attacks of microbes as to the chastenings of his fellows.

hygiene

THE LANCET LONDON: SATURDAY, JUNE 9, 19344

SCHOOL EPIDEMICS IT is not easy for the school medical officer to handle the problem of infectious disease in a way that will please everyone. Caution in his methods of isolation leads the parent to complain that his money and the child’s time are being wasted ; laxity lays him open to censure. The old-fashioned seemed content to look upon the public school as a place where the character and physique of his children were hardened and prepared for the larger world. The weakest went to the wall and the survivors emerged morally and physically " salted." The parent of to-day expects a large measure of individual care, both as regards mind and body, to be given, and unflagging efforts are made by school-masters, medical officers, and others to provide this care. Nor is the effort restricted to individual schools and their officers. The modern school doctor exchanges frequent notes with his colleagues elsewhere on matters of school hygiene. For some years past the Medical Research Council have had a special committee for the investigation of school epidemics; 30 large public schools cooperate in keeping this committee continuously informed of what is happening in the schools. Already valuable information has been acquired. Special laboratory investigations have been carried out using the material provided by those schools. Among the more important results have been those submitted by J. A. GLOVER and F. GRIFFITH on streptococcal infections in schools. Much light has been shed on the spread of conditions due the to infection with heemolytic streptococci; cumulative effect of nasopharyngeal epidemics is recognised, and that an epidemic of colds may lead to an outbreak of sore-throat, which in its turn may give rise to otitis or mastoiditis. An epidemic of scarlet fever may be concealed in such apparently

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modest manifestations.

PERIPHERAL VASCULAR DISEASE THE relief which surgery can afford in certain

disorders of the peripheral blood-vessels has There is instruction to be gained from contrasting aroused a growing interest in the selection of girls’ schools with boys’. As compared with boys, cases suitable for operation, and consequently in girls have had less than half the incidence of the pathology of arterial obstruction. The study otitis media and pneumonia, and only one-eighth of patients showing the various manifestations of the incidence of sinusitis. This may be ascribed peripheral vascular disease has exposed our lack in part to the greater care and supervision which of knowledge of the processes which bring about girls receive, but is probably more closely connected changes in colour, temperature, and sensation in with the better sleeping accommodation at the the affected extremities, and the need to develop girls’ schools. Most modern observers have em- methods of investigation which besides giving phasised the importance of dormitories as breeding reliable information with regard to the state of grounds for epidemics. There is little doubt that the arteries, arterioles, and capillaries, will also better dormitory conditions and less overcrowding indicate the value of various forms of treatment. would improve the hygienic reputation of some of Steps in this direction are being made in centres our public schools. In this direction, at least, the of clinical research in this country and in the schools themselves have an ample field for effort, United States, and workers in the vascular disease and it is but fair to say that most of them are clinics established respectively in Chicago and in Cincinnati have recently described their routine doing as much as their finances allow. One of the outstanding things in modern school methods of examining patients. -