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These children would heretofore have continued to attend school, spreading the disease and
ultimately causing much loss of attendance.
During the same period many certificates were received from medical men, both in public and
private practice, stating that children either were not suffering, or had recovered from the disease. In
72 of these cases the nurses were so doubtful of the children being really free from infection that they
forwarded stumps for microscopical examination. Ringworm was found in 66 cases, favus in 4 cases,
and in the remaining 2 cases the microscopic examination was negative. All cases are regarded as
infectious where broken off stumps are found after careful examination of the scalp with a lens, and
where such stumps on removal and after being washed with ether and mounted for a few minutes in
10 per cent. potash solution show abundance of spores of ringworm.
Ringworm, then, is widely spread. It exists in several varieties. Some cases are very obstinate,
and most cases are infectious for long periods. It is not fatal; scarcely ever disables the patient, and
tends to spontaneous recovery about the end of school life, but the interruption of school work is a very
serious matter.
The following courses might be followed: (a) neglect the disease altogether; (b) continue the present
policy of exclusion; or (c) adopt a very rigorous policy of repression, necessitating the provision
of ringworm classes.
The policy of exclusion should be continued for the present and the question of the formation of
ringworm classes be considered when the favus school has been in working order for a time and when their
use could be supplemented by centres for treatment.
Favus.—A year ago it was recorded that in a small district of the East End we knew 79 cases
of favus in school children, and that it had been decided to open a "favus school." The arrangements
have all been waiting the completion of the buildings, which are to be ready in June.*
The ease with which cases can be missed and the practical impossibility of cure were mentioned.
Since then Dr. Bertram Abrahams has turned his attention to this disease. He was given willing and
intelligent help by the teachers in all departments and he has examined every child in 21 schools of
the Whitechapel, Stepney, Mile End, Shoreditch, Commercial-road and St. George's districts. Each
child was inspected, and any which presented suspicious spots had hairs removed and microscopically
examined after treatment with caustic soda solution. Gram's method of staining the fungus was
applied as a confirmatory test. A few cultures were also kindly made for him by Dr. I. M. Bernstein in
the clinical laboratory of the Westminster Hospital. Hairs were also taken from all cases which had
been re-admitted as cured.
Prevalence.—In the schools examined, despite the fact that 79 had been excluded during the
previous year, 51 fresh cases were found. The attendance in these schools represented roundly
6,600 boys, 6,400 girls and 9,200 infants. Total 22,200.
In 225 cases hairs were repeatedly examined and in 66 the fungus found. Including cases excluded
previously there were 90 altogether, or 0.4 per cent. Of the 66 there were 30 boys, 16 girls,
19 in infants and one in a special school. Thirty-nine of the cases were seen in the lower four standards
of the boys' and girls' schools, and 62 of the 66 were in children of foreign parents, but this is not out
of the way considering the large alien population of this area.
Of seventeen children who had been permitted to return to school as cured the fungus was found
in eleven. In one case already excluded as favus no fungus could be found.
Clinically very few cases presented the typical yellow cups, and the "mousy" odour described
as characteristic was not once detected except where crusts were present. The diagnosis without
microscopical examination was impossible in many cases, especially when treatment by ointments had
modified the appearance. Frequently favus was complicated with impetigo, which added to the difficulty
of diagnosis. In one case the character of the disease was masked by a growth having the appearance
and structure of papilloma. Yellow crusts were often met with not due to favus, but an orange tint
generally was associated with the fungus.
The subjects of favus were often found to be children of poor physique and low nutrition.
The disease does not appear to be highly contagious as only two pairs of cases occurred in the
same family, although another case had a brother already excluded for the disease. Some of the worst
cases were the single affected members of large families.
Some of the cases observed had persisted for years; two-thirds of those returned to school as cured
were found still affected. The disease appears sometimes to wear itself out, particularly if the general
health improves, but no case was seen in which cure could be ascribed to medical means.
The duty of the Council is to protect the healthy. Cases of favus are, therefore, permanently
excluded, and soon they will be under education in a special school. The great cost of the special
* The school was opened 6th June, 1906, with 61 scholars: