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THE INFLUENCE OF SCHOOLS IN ACCENTUATING THE SPREAD OF CERTAIN INFECTIOUS DISEASES.
256 his opinion there was ample control over the affairs of the company. Their accounts were examined by the auditor appointed by the Local Government Board ; the filtration of their water was watched and reported on by the water examiner to the Local Government Board, and he would have no objection whatever to the water examiner having a statutory right to enter their premises at all times. The witness said that in his opinion the undertakings of the metropolitan water companies were too great to be under one management unless a separate Government department were formed for that purpose. The CHAIRMAN remarked that Government departments were not always considered to be models of efficient supervision. The forty-sixth meeting of the Royal Commissioners was held at the Guildhall, Westminster, on Jan. 24th, when the examination of Mr. Bowles was completed and Mr. Searle, the secretary, and Mr. Francis, the engineer to the New River Company, were examined by the Commissioners. The latter was cross-examined at some length by Lord Robert Cecil on behalf of the Hertfordshire County Council.
THE INFLUENCE OF SCHOOLS IN ACCENTUATING THE SPREAD OF CERTAIN
INFECTIOUS DISEASES. II. Ix our last article in THE LANCET of Jan. 21st we briefly traced the growth of knowledge as to the influence of schools in connexion with the diffusion of infectious disease, and we drew attention to the valuable and instructive investigations of Mr. Shirley Murphy with regard to the elementary schools of the metropolis. If, however, schools have had a marked effect in accentuating the incidence of diphtheria and other infectious diseases on certain age groups in London, it is only reasonable to expect that a somewhat similar influence should, if carefully looked for, be detectable elsewhere. But at the threshold of an inquiry into this aspect of the question we are met with the difficulty that in but few places has such care been exercised to discover the facts as has been taken by Mr. Murphy in connexion with the London figures; indeed, some investigators have by a somewhat imperfect conception of the real issues at stake needlessly complicated matters. If, however, the mortality figures for England and Wales, excluding London, are studied as a whole it is found that they manifest similar changes to those for London taken either alone or in conjunction with those for England and Wales, and as Mr. Murphy points out in the reportwith which we are now mainly dealing, there has been in each of the populations above referred to a notable increase of relative incidences of diphtheria mortality since 1861-70 upon children at school age, andso far as the figures antecedent to the period 1861-70 may be trusted, there is observable difference in the behaviour of the figures in the period before and after that period." Mr. Murphy discusses ’ the several factors which may be considered to have had to do with this altered age incidence, such, for instance, as I altered nomenclature, natural variations, and varying social conditions of the community, and after fully dealing with each of these questions he arrives at the conclusion that the aggregation of children in schools is the best explanation of the phenomena observed. When, too, the available notification figures for certain large towns other than London are separately examined as regards diphtheria incidences on age groups Mr. Murphy finds, contrary to the conclusions arrived at by Dr. W. R. Smith, the medical officer of the London School Board, who it appears examined only the "all ages" figures for some of these towns, that there are distinct indications of a fall in the number of notifications during the summer holiday period in the case of Bradford, Birmingham, Nottingham, West Ham, Salford, Sheffield, Bristol, and Manchester. These results have been brought out by 1 London County Council Paper: Report by the Medical Officer of Health on Diphtheria and Elementary Schools. No. 399. Price 1s.; post free 1s. 1½d. P. S. King and Son, 9, Bridge-street, Westminster, S.W.
grouping the cases in respect to age for three equal periodsi.e., before holiday influence, during holiday influence, anj) subsequently to holiday influence. So, too, in reference to thefigures for Berlin, Mr. Murphy, without of course attaching any great importance to"all agesfigures, shows never-
theless that there are even here indications of scho01 influence, and this in spite of the fact that Dr. Smith, who. had regard to the deaths alone, failed to detect any such influence. There is, however, another side from which this question of school influence may be approached, and that, is by a consideration of the operations of each separate school in any given district. It is perfectly obvious to the epidemiologist that all schools are not always operating in the diffusion of infectious disease, and it is probable that au times no school in a given locality may be thus operating. This being so the influence for harm of any given school oc schools may be swamped as it were by the negative influenceof many other schools. Dr. Niven, the medical officer of health of Manchester, has been at pains to consider the scarlet fever incidence in relation to each school in his. district, and in his last annual report he shows very clearly how while the majority of schools were, during the period to which the inquiries related, not potent for mischief, others. were very materially so ; and his study shows further the necessity of approaching the operations of any given school by a separate examination of each of the departments of that school. As Dr. Niven observes at the conclusion of his investigations, " the statistics given by Mr. Shirley Murphy are clearly supported by this inquiry as to fact and signif ficance." We do not propose to further discuss the manner in which Dr. W. R. Smith’s arguments are dealt with by Mr. Murphy in his report now before us, inasmuch as we noticed Dr. Smith’s report at some length in our columns at the time of its publication in 1896.2 It seemed to us then, and it seems to us still, that much of that report was not altogether relevant to the issue, For instance, Dr. Smith discussed the incidence on several counties or groups of counties in England, and, in consequence of the unequal and varying incidence’of the disease on the several areas, he was apparently led’ towards his conclusion that schools exercised but an unimportant influence in the spread of diphtheria. For our part we have never been able to see the force of this argument, and it would seem to us to be equally illogical to infer that because the incidence of enteric fever varies very materially in different counties and parts of England, and that it may at times be difficult to determine the part which specifically contaminated water may have had in the spread of the disease that therefore the influence which contaminated water has had in the country as a whole i "unimportant"and no very special measures have been needed to check its operations. The bacillus of enteric fever is, as far as we can ascertain or infer, not always present in our public water-supplies, and even when it is present it but rarely finds itself under conditions prone to its multiplication. Similarly with respect to diphtheria the bacillus of that disease is not always present in all our elementary schools and when it does obtain entry therein the conditions necessary for promoting a high degree of infectivity are doubtless often absent. In our view, however, the question of polluted watersupplies and of the spread of infectious disease by means cf elementary schools both need vigorously dealing with, and in our next article we shall discuss the improvements in this direction of school regulations.
HUNTER
v.
CLARE.
IN the Queen’s Bench Division of the Royal Courts of Justice on Jan. 24th this case was heard before Mr. Justice Lawrance and Mr. Justice Channell. Mr. Hall dane, Q.C., and Mr. Condy appeared for the appellant and Mr. Muir Mackenzie for the respondent. The real parties to the dispute were the Society of Apothecaries on the one hand and the General Medical Council on the other. Th question at issue was whether a Licentiate of the Society of Apothecaries was entitled to describe himself as a physician. The present case was one stated by the 2
THE LANCET
May 23rd, 1896,
and June
13th, 1896.
THE INFLUENCE OF SCHOOLS IN ACCENTUATING THE SPREAD OF CERTAIN
INFECTIOUS DISEASES. II. Ix our last article in THE LANCET of Jan. 21st we briefly traced the growth of knowledge as to the influence of schools in connexion with the diffusion of infectious disease, and we drew attention to the valuable and instructive investigations of Mr. Shirley Murphy with regard to the elementary schools of the metropolis. If, however, schools have had a marked effect in accentuating the incidence of diphtheria and other infectious diseases on certain age groups in London, it is only reasonable to expect that a somewhat similar influence should, if carefully looked for, be detectable elsewhere. But at the threshold of an inquiry into this aspect of the question we are met with the difficulty that in but few places has such care been exercised to discover the facts as has been taken by Mr. Murphy in connexion with the London figures; indeed, some investigators have by a somewhat imperfect conception of the real issues at stake needlessly complicated matters. If, however, the mortality figures for England and Wales, excluding London, are studied as a whole it is found that they manifest similar changes to those for London taken either alone or in conjunction with those for England and Wales, and as Mr. Murphy points out in the reportwith which we are now mainly dealing, there has been in each of the populations above referred to a notable increase of relative incidences of diphtheria mortality since 1861-70 upon children at school age, andso far as the figures antecedent to the period 1861-70 may be trusted, there is observable difference in the behaviour of the figures in the period before and after that period." Mr. Murphy discusses ’ the several factors which may be considered to have had to do with this altered age incidence, such, for instance, as I altered nomenclature, natural variations, and varying social conditions of the community, and after fully dealing with each of these questions he arrives at the conclusion that the aggregation of children in schools is the best explanation of the phenomena observed. When, too, the available notification figures for certain large towns other than London are separately examined as regards diphtheria incidences on age groups Mr. Murphy finds, contrary to the conclusions arrived at by Dr. W. R. Smith, the medical officer of the London School Board, who it appears examined only the "all ages" figures for some of these towns, that there are distinct indications of a fall in the number of notifications during the summer holiday period in the case of Bradford, Birmingham, Nottingham, West Ham, Salford, Sheffield, Bristol, and Manchester. These results have been brought out by 1 London County Council Paper: Report by the Medical Officer of Health on Diphtheria and Elementary Schools. No. 399. Price 1s.; post free 1s. 1½d. P. S. King and Son, 9, Bridge-street, Westminster, S.W.
grouping the cases in respect to age for three equal periodsi.e., before holiday influence, during holiday influence, anj) subsequently to holiday influence. So, too, in reference to thefigures for Berlin, Mr. Murphy, without of course attaching any great importance to"all agesfigures, shows never-
theless that there are even here indications of scho01 influence, and this in spite of the fact that Dr. Smith, who. had regard to the deaths alone, failed to detect any such influence. There is, however, another side from which this question of school influence may be approached, and that, is by a consideration of the operations of each separate school in any given district. It is perfectly obvious to the epidemiologist that all schools are not always operating in the diffusion of infectious disease, and it is probable that au times no school in a given locality may be thus operating. This being so the influence for harm of any given school oc schools may be swamped as it were by the negative influenceof many other schools. Dr. Niven, the medical officer of health of Manchester, has been at pains to consider the scarlet fever incidence in relation to each school in his. district, and in his last annual report he shows very clearly how while the majority of schools were, during the period to which the inquiries related, not potent for mischief, others. were very materially so ; and his study shows further the necessity of approaching the operations of any given school by a separate examination of each of the departments of that school. As Dr. Niven observes at the conclusion of his investigations, " the statistics given by Mr. Shirley Murphy are clearly supported by this inquiry as to fact and signif ficance." We do not propose to further discuss the manner in which Dr. W. R. Smith’s arguments are dealt with by Mr. Murphy in his report now before us, inasmuch as we noticed Dr. Smith’s report at some length in our columns at the time of its publication in 1896.2 It seemed to us then, and it seems to us still, that much of that report was not altogether relevant to the issue, For instance, Dr. Smith discussed the incidence on several counties or groups of counties in England, and, in consequence of the unequal and varying incidence’of the disease on the several areas, he was apparently led’ towards his conclusion that schools exercised but an unimportant influence in the spread of diphtheria. For our part we have never been able to see the force of this argument, and it would seem to us to be equally illogical to infer that because the incidence of enteric fever varies very materially in different counties and parts of England, and that it may at times be difficult to determine the part which specifically contaminated water may have had in the spread of the disease that therefore the influence which contaminated water has had in the country as a whole i "unimportant"and no very special measures have been needed to check its operations. The bacillus of enteric fever is, as far as we can ascertain or infer, not always present in our public water-supplies, and even when it is present it but rarely finds itself under conditions prone to its multiplication. Similarly with respect to diphtheria the bacillus of that disease is not always present in all our elementary schools and when it does obtain entry therein the conditions necessary for promoting a high degree of infectivity are doubtless often absent. In our view, however, the question of polluted watersupplies and of the spread of infectious disease by means cf elementary schools both need vigorously dealing with, and in our next article we shall discuss the improvements in this direction of school regulations.
HUNTER
v.
CLARE.
IN the Queen’s Bench Division of the Royal Courts of Justice on Jan. 24th this case was heard before Mr. Justice Lawrance and Mr. Justice Channell. Mr. Hall dane, Q.C., and Mr. Condy appeared for the appellant and Mr. Muir Mackenzie for the respondent. The real parties to the dispute were the Society of Apothecaries on the one hand and the General Medical Council on the other. Th question at issue was whether a Licentiate of the Society of Apothecaries was entitled to describe himself as a physician. The present case was one stated by the 2
THE LANCET
May 23rd, 1896,
and June
13th, 1896.