School Sanitation at Blackburn.

840

SCHOOL SANITATION AT BLACKBURN.

who

might in their turn convey the necessary instructions to mothers in their own homes, doubtless beneficial results the would follow. As is well known, milk is liable to decom-

will in the future be either justified or condemned, and the of his report may be taken as an eminently hopeful indication of their intentions. In the meanwhile

publication

cleanliness it is satisfactory to note that the quality of schoolroom air, is observed in regard to the vessels in which the milk is as tested by the quantity of carbon dioxide, has definitely kept, particularly the feeding bottles, evil results will improved in Blackburn since the date of an examination surely follow. We have frequently pointed out the duties made seven years ago, and Dr. GREENWOOD attributes the which devolve upon medical practitioners in educating improvement to a better recognition of the importance of patient,> suffering from pulmonary tuberculosis as to the ventilation by the teachers. The chapter of the report relating to the bacteriology of prophylactic measures which they should adopt in order to in So the schoolroom air can only be described as somewhat meagre, prevent themselves becoming a danger to others. matter of the artificial feeding of children a little instruction or at least as descriptive of researches which might have in hot weather and unless

position

to the mothers and

scrupulous

supervision of the surroundings would in the prevention of one of the most

doubtless do much fatal of infantile diseases.

School Sanitation at Blackburn. THE Health and Education Committees of the

County Borough aBlackburn have given very remarkable evidence of the excellent spirit in which they have entered upon the important duties imposed upon them by the Education Act and have set an example which will, we hope, be widely followed in other localities. They have instructed their medical officer, Dr. ALFRED GREENWOOD, to make a complete investigation into the sanitary conditions of the 52 public elementary schools under their jurisdiction and his

octavo volume of over 400 pages, with of the schools and numerous tables, has plans been published under their direction. Dr. GREENWOOD, it is hardly necessary to .say, has acquitted himself in the most admirable manner and has produced a report which may well serve as a model for any who are called He first summarises upon to undertake similar duties. the rules for planning elementary schools which have been issued by the Board of Education, comparing them in some respects, and not always to their advantage, with those which are in operation in America; and after a general dissNssion of the questions of superficial and cubic space, of roofs, entrances, and staircases, of cloak rooms and lavatorie-s, of lighting, of ventilation, of warming, of sanitary arrangements, of desks and seats, of water-supply, of sites and playgrounds, and of infants’ schools, he gives a copy of the form which he employed for the purpose of systematically recording the results of his inspections-a form in which no single point appears to have been overlooked. A second chapter gives the detailed results of this

report,

an

detailed

inspection

school, with a plan and measurements of each, and with definite recommendations for

for every

every room in the eofrestien of every defect that was discovered. The third chapter contains the results of a chemical examination of

the air of sehools for carbon dioxide ; the fourth, the results of a ’feriologiea9 examination; and the fifth is devoted to general recemmenda.tions in addition to the specific ones made for each school. The total result is that a comparison of the volume with the state of the schools at any future time win afford oonclusive evidence of the extent to which the committees concerned have set themselves to remedy faatts which have been officially brought under their notice ond of which no one can now profess to be ignorant. Out of the mouth of their own officer the Blackburn authorities

been extended with

advantage. They consisted only of the

exposure in the rooms for short periods of gelatin or agar plates and of the subsequent counting of the colonies which grew upon them, without any attempt to determine the precise character of the bacteria concerned or the sources from which

derived. Dr. GREENWOOD makes no reference to the work of FLUGGE on the identification of

they

were

salivary bacteria suspended in the atmosphere-work which, if we are correctly informed, has recently been considerably extended by inquirers in this country, with especial reference to the distribution of such bacteria by speaking laughing, sneezing, coughing, or even by ordinary expiration. Many of our readers will remember a picture by MULREADY, now in the South Kensington Gallery, entitled "Choosing the Wedding Dress." It hangs at about sight level, and after

it had been exhibited for two

or

three

years the attention of the keeper of the gallery was directed to a marked change in the character of its surface-a change which was traced to the number of

droplets

projection-jagainst

it of

an

of saliva from visitors who had

in front of it and had

infinite

stopped

they looked. The resultlaughed ing film of dried saliva was cleaned away and the picture This coarse was then placed under glass for its protection. more delicate ones to which we experiment, as well as the have referred, must be held to show the importance of the as

bacteriological study of schoolroom air in relation to the spread of many infectious diseases, and not merely, as Dr. GREENWOOD appears to have regarded it, as a measure of atmospheric impurity. Even in this form, as it does not appear to have been employed previously at Blackburn, there are no data for a comparison between the present and earlier times ; but it may be assumed that observations of a similar kind will be continued and extended, and that important results are likely to be obtained from them. It would, of course, be of special importance to examine suspended salivary bacteria at periods when diphtheria or other diseases affecting mucous membranes were prevalent in the district, and it is quite possible that timely warnings of danger might in this way be obtained. We cannot leave the

calling

attention to

an

subject of

school sanitation without

extremely:’interesting pamphlet, re-

from the Atedical Oh’l’oniole for June, in which Dr. R. T. WILLIAMSON of Manchester, the delegate from the Victoria University of Manchester and the Manchester and

printed

Salford Sanitary Association to

the first International of School Hygiene, heldin April at Nuremberg, Congress sives an account of the proceedings in which he took part.

long been laxge proportion of [t has

evident totophthalmic surgeons that a the boob used in schools are printed in

HEALTH AND EDUCATION.-DIFFICULTIES OF CHLOROFORMISATION.

such small and crowded type as to be exceedingly objectionable ; and Dr. WILLIAMSON quotes from COHN a simple test of the fitness of a printed page for school use which ought to be universally known and employed. It consists of an ordinary card, say a visiting card, in the centre of which a

square hole

is cut, each side of which measures exactly one centimetre. The card with the centimetre square hole is placed upon the page to be tested, the lower margin of the hole being immediately above a line of print. If the type be

satisfactory only two lines of print can be seen within and, according to COHN, all books should be

the square,

condemned in which this condition is not fulfilled. account is

given

of

a

very

and

simple

ingenious

trivance, also devised by COHN, for testing the of every part of a room, the requirement to

being

that at least 20 small

seconds at

a

figures

An con-

illumination be fulfilled

should be read in 30

distance of 40 centimetres from the eyes.

Dr.

schools themselves. In this connexion the report of the committee intrusted by the British Association for the Advancement of Science with the duty of inquiring into the conditions of health essential to the carrying on of the work of instruction in schools has naturally been received with This report, which was rece3aily considerable interest. read at the meeting of the association at Cambridge, embodied, among a number of other important cansiderations, draft recommendations for a course of st-cëJy in hygiene to be pursued by those proposing to act as teachers in the public elementary schools. The proposed curriculum, though necessarily incomplete and schematic. cannot be regarded otherwise than as well adapted for fulfilling the purposes for which it is intended—that is to say, of providing a course of instruction in hygieme for teachers which will not only enable them in their turn 10 instruct their pupils in the ways of personal health but alsc to conduct the general management of the schools and class rooms with an intelligent appreciation of the aims and objects of hygiene and sanitation.

GREENWOOD and other medical officers of health who, like him, feel the importance of such an extension of their work as may bring the requirements of schools completely within their cognisance and under their control, may render good service by directing the attention of their committees to many matters of this kind, and it may be hoped that when the second International Congress is held in London in 1907 the contributions of Englishmen to its proceedings will be of sufficient number and importance to show that the value of the children of the nation, as part of its capital and as a support when speaking with its enemies in the gate, has not been lost sight of either by the members of the medical profession or by the various and sometimes rather heterogeneous local authorities to whose tender mercies the education of these children has ’h""" (>"mmiH,,,iI

Annotations. "Ne quid nimis."

HEALTH AND

841

EDUCATION.

ONE of the most serious obstacles to the progress of reform in this, as, indeed, in most other countries, has been, and is, the indifference on the part of the masses to all ordinary considerations of personal hygiene. The public health in the aggregate mainly depends on the hygienic morality of the individual. No legislation can enforce the open window any more than it can stop expectoration in the The only practical measure which holds out streets. any prospect of success of improving the standard of personal hygiene among the people is to educate the rising generation in its elementary principles and in the advantages which are likely to accrue from their observance. That this method of utilising the receptiveness of the child’s mind and of reaching the objective by a route apparently so circuitous is founded on sound principles and fruitful in practice is clearly evidenced by the marked improvement in the general appearance of neatness and cleanliness of the children who attend at the public’ elementary schools. But to engender a proper sense of the advantages of an enlightened domestic and personal hygiene it is not only necessary that the teachers themselves should have an adequate knowledge of the essentials; of sanitation and hygiene, but also that the precepts which they teach should be pushed home by example and ztrict observance of their laws in the administration of the

sanitary

,

.

by a

DIFFICULTIES OF CHLOROFORMISATION. THE extreme difficulty which often confronts the amesthetist is well illustrated in the clear notes furnished to us of a death under chloroform. The method which appears to have been carried out carefully is one which must always render irregular doses of chloroform possible. Care, such as was used in the present case, and experience "NBdoubte{11y lessen its dangers and many competent authorities :n:ay upon the method and even regard it as one of the êest competent hands. The facts of the case are as follows. On August 16th the patient, a male, aged 30 years, an exsoldier, of somewhat slight physique and pale comp-Iexios, was anaesthetised in order to have a necrosed femur Examination on. operated prior to administration of the anaesthetic showed the chest, heart, and lungs to be apparently normal. Chloroform was given from a drop-bott]e-on a flannel mask. The patient passed easily to the second degree of anaesthesia, when he struggled with his arms for a second or two and then went on quietly taking the anaesthetic until the breathing being quiet and regular, the pulse about 90 and of fair quality, the pupils about three and a half millimetres, and colour as at the commencement of anaesthesia, he was wheeled into the theatre from the adjacent room and put on the table. Direc Lly this was do]]c the face became pale, the lips and ears cyanosed, the patient gave about eight or ten gasping inspirations like the inspilation of air-hunger, and respiration ceased. Immediately on the alteration of the colour and respiration the head was lowered and artificial respiration was commenced, and a hypodermic injection of strychnine and an enema of brandy were given. The administration of the chloroform had been stopped whilst the patient was being lifted from the stretcher The heart failed when the change of on to the table. colour took place before the complete cessation of mpikation ; this observation was made by the surgeon in charge of the case. Artificial respiration was persisted in for threeThe adminisquarters of an hour but without result. tration of the anaesthetic had been in progress for seven minutes ; the amount of chloroform used was three and a half drachms. No necropsy was made. The salient features about the case, so far as can be judged without having witnessed the phenomena exhibited by the patient, appear to be : slight struggling, such as is common to the second degree of chloroform narcosis and failure of respiration ensuing upon lifting the patient from the wheeled couch on to the operating-table. We may presume that during this struggling the chloroform mask was removed from the patient’s face. If this were not so an overdose would readily be given and its results might not show themselves