296 



NATURE 



[April 27, 191 1 



including lakes and pondt, streami, springs, wells, and 

 cisterns, and the opinion is expressed that, of all these 

 sources of supply, ground water ik the most satisfactory 

 for farm une, because it is least liable to pollution, and 

 that streams and ponds are least trustworthy, because of 

 the ease and frequency with which they are contaminated. 

 Next follows a general description of ir ' - nd waters 

 and of the means to be adopted for th< on. The 



information on the subject of wells is c _ and com- 

 plete, and inclufli-s sunw useful statistics of the cost of the 

 various types, and a tal>ul.-ir statement of their advantages 

 and disadvantages. The " safety distance " from possible 

 sources of ix>llution is discussed, and that recommended 

 ranges from loo feet in clay and shale to aoo feet and 

 more in sand and gravel. Boring tools and appliances 

 and the methods of sinking wells are illustrated by 

 diagrams and phdtographs. Altogether, the manual is one 

 to be cordially coinuvndcd for careful perusal and study 

 by those dependent for water supply on local and adven- 

 titious sources. 



It is interesting to note the author's remarks on the 

 use of the " divining rod " for detecting the presence of 

 underground water. He is of opinion that the alleged 

 automatic deflection of the rod can only be attributable to 

 unconscious muscular action, and that, however honestly 

 the operator may believe in the reality of his powers, the 

 irregularity of the results obtained and the numerous 

 instances of failure recorded indicate that the system is 

 crude, merelv experimental, and quite untrustworthy. 



B. C. 



SCHOOL MEDICAL SERVICE.' 



/^NLY to those familiar with the origins of the medical 

 ^^ inspection movement is it credible that, in little 

 more than four years, a system should have developed 

 that needs a Blue-book of upwards of 200 pages even for 

 a brief summary of the work. The second report of Sir 

 George Newman, chief medical officer to the Board 

 of Education, shows that the system of medical inspection 

 is now a fully organised service, producing its multitudes 

 of new facts and propounding innumerable problems of 

 detail. 



Section I. deals with administration. The statement of 

 policy is unambiguous. " From the outset the Board took 

 the view that the Medical Inspection of School Children 

 was but one of a number of activities comprised in School 

 Hygiene, and the science and art of School Hygiene itself 

 could not be regarded as an independent science and art 

 which could be pursued in detachment from other studies, 

 but was, in fact, an integral and vital part of that science 

 which, under the name of Public Health, deals with all 

 questions affecting the health and physical condition of 

 the nation " (p. 3). Time alone can fully justify this 

 statement ; but, from the beginning, it appealed to the 

 administrative mind. The creation of rival services for 

 inseparable departments of health would have meant that 

 one service would ultimately be superseded. The return 

 of the public health officers into touch with the individual 

 children has undoubtedly restored to that service a unity 

 of purpose that it should never have lost. Preventive 

 medicine includes personal as well as environmental 

 hygiene. 



This report contains much material to justify the 

 Board's policy. Of the schedule used, it is important to 

 record that "it is not, and never was, intended to be 

 merely a means of collecting statistics. . . . The intention 

 of Parliament was clearly that Medical Inspection should 

 be of a practical character, and have practical rather than 

 academic results " (p. 8). This is a timely warning 

 against the danger of statistics heaped up without any 

 synthetic idea. Nothing more disconcerts the man of 

 practice, who, in this question, is more important as yet 

 than the man of theory. On the whole, this year's re- 

 ports come well out of the test. The medical men 

 engaged in the medical school service number approxi- 

 mately 986 ; there are 73 women doctors and 289 nurses. 



Section II. deals with the physical condition of the 

 children as revealed by medical inspection. There are 



1 Annual Report for 1909 of the Chief Medical OfScer of the Board of 

 Education Pp. 213. (London : H.M. Stationery Office, 1910.) Price ii</. 



NO. 2165, VOL. se"! 



' many interesting percentage as to cleanliness. Pedi c ulogi 

 is all too common, but the systematic schem>-s of ileansiii, 

 have effected immense improvements. In' 

 schemes will help in the control of less c 

 parasites. There is abundant evidence that lav 

 accommodation and spray baths are on the increase, 

 it is certainly disappointing to have to read that 

 36 per cent., there 15 per cent., elsewhere si per c- t , 

 should suffer from vermin. It is, on the other 'u- 

 gratifying to find that, in one case, the 36 per cent. <>i 

 one examination fell to 9 per cent, on the second examina 

 tion, and this over a total of more than 3000 child; 

 Obviously the activity of the parents has been st.:. 

 lated by the concentration of attention on the para»iU< 

 state. Ring-worm is extremely common. This trouble- 

 some and wearisome ailment ought to be extinguished, but 

 its extinction will be difficult. In some counties the cases 

 amount to i in 73, in others to i in 45. In one town 

 the cases were i in 67, in another i in 1000. Adenoid^ 

 and enlarged tonsils and glands have contributed largely 

 to the recorded ailments. So have defective hearing and 

 defective vision. It is impossible to summarise the masses 

 of facts and methods here detailed, but the special atten- 

 tion directed to the respiratory passages may be expected. 

 in the long run, to reduce malnutrition and early tubercu- 

 losis. Heart disease should also profit by the inspection. 

 One school medical officer reports "' 1-7 per cent, of hf-art 

 disease among all children examined at five and thirteen 

 years," but he adds that " three times as many suffer 

 from hypertrophy or dilatation " (p. 61). .\nother found 

 2-3 per cent, among five-year-old children and 1-2 per cent. 

 among twelve-year-old children. The association of heart 

 disease with rheumatism has been carefully studied by 

 some medical officers. Factors in the production of 

 " dilated heart are anaemia, over-strain, work out of 

 school hours, and cigarette smoking " (p. 62). Of seventy- 

 six boys examined for " heart strain due to double digging 

 undertaken in connection with the garden classes," nine 

 showed signs of rheumatic heart disease, and " in 

 eighteen other cases signs of heart strain were discovered " 

 (p. 61). These facts are of fundamental importance in 

 physical education. The whole question of the " rheu- 

 matism of children and adolescents " demands careful 

 investigation. 



The section on tuberculosis contains many facts of great 

 importance. " It is interesting to observe that the per- 

 centage of tuberculosis among the routine cases is found 

 to be 0-75 in 1909 as against 102 in 1908, and among the 

 routine and special cases 1-22 in 1909 as against 1-31 in 

 1908. Among the special cases, the percentage shows a 

 slight rise — 2-02 in 1909 as compared with 1-97 in 1908 " 

 (p. 63). These figures refer to 683,715 children exam ••d 

 in 1909, as compared with 245,000 in 1908. It is not 

 indicated whether any special reaction methods have 

 used in diagnosis. The amount of tuberculosis disco. i 

 in different localities varies enormously ; but the results, 

 if based simply on ordinary clinical inspection, cannot be 

 accepted as indicating the full extent of tubercular pre- 

 valence. " The prevalence of phthisis among school 

 children is still a matter upon which great differences 

 exist among school medical officers, and this will continue 

 to be the case until definite standards of diagnosis are 

 introduced " (p. 66). The results recorded abroad from 

 von Pirquet's reaction are in entire discord with the facts 

 recorded here. It is obvious that the whole question oi 

 the prevalence of tuberculosis needs investigation de novo. 

 It is a question of primary importance, not merely for 

 practice, but for correct inferences as to heredit}*. If, as 

 one observer (Dr. Herford, of Altona) finds, that, in ar 

 examination of 2594 school children, " 63 per cent, reacted. 

 50 per cent, of the five-year-old groups, and 94 per cent. 

 of those about to leave school " (p. 66), and if these results 

 be verified, we must suspend judgment on the whok 

 question of prevalence. If those results are correct 

 masses of statements about " tubercular diathesis " anc 

 " intensity of inheritance " fall to the ground. The in 

 crease of open-air schools is a gratifying practical result. 



Section III., on "following up," contains a good dea 

 of important practice. Section IV. indicates the rantje o 

 " medical treatment," including the improvement of srhoo 

 arrangements, sanitation, physical exercises, open-ai 

 classes, powers under special Acts for blind, deaf, defec 



