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It has been established that the risk of re-infection in the school is almost negligible. Dust taken
from various parts of the school repeatedly failed to give any favus cultures, although they were easily
obtained from hairs or scales direct from the children's heads. A table of the results of treatment
published in the last Annual Report showed how ineffective various measures for the relief of favus
seemed to be. The fault could not be said to depend on either the hospital or the medical men, as a
great deal has to be left to the parents. Ignorance, apathy or mere laziness, lead to neglect, and the
fungus retains its hold especially in the deeper parts of the skin around the hairs. No case was therefore
regarded as cured in which repeated microscopic investigation of hair stumps failed to detect the fungus
unless it had remained clear for three months. The sanitary routine of the school is now applied to
each of the children. Children on admission to the school are generally found in all degrees of uncleanness.
The scalp is covered with yellowish, crusted dimpled patches, sometimes purulent, but more
generally with sticky honey like secretion. The purulent cases occasionally have a faint odour, otherwise
the characteristic mousy odour mentioned in the text books is but rarely noticed. The hair is cut very
short once a week with clippers. The head is then washed with plenty of soft soap ; a knitted headflannel
and towel is used, and each is marked with the child's name. After use the towel and flannel
are placed in disinfectant solution and all the head-flannels are boiled in the evening after being used.
If there are many scabs when the child is admitted the head is poulticed each morning with linseed and
a small proportion of cyllin, about one part in 200 of the water used for the poultice. The heads are
also washed daily. When poulticing is not required a compress of perchloride of mercury solution,
one in 250, with glycerin one in 10 or 12 or a compress of cyllin solution is used. The cyllin solution
may be increased in strength till in some cases the pure solution is painted on. The cyllin is merely
used as a convenient disinfectant, no doubt many other similar materials would be equally applicable
and equally effective. All the children have the patches treated daily with white precipitate ointment,
one in three, after washing, and before going home. This is continued till no fungus can be detected
in the stumps when all treatment is withdrawn and the case kept under observation. At the end of
three months, without recurrence it is pronounced cured and discharged. The routine is kept up during
the holidays. During the past year 19 cases have been discharged after the severe test of watching
three months for recurrence. These recoveries appear due to the treatment of this routine as worked
out by Dr. Abrahams. But many cases somewhat improved still remain and the results, although
brilliant for favus treatment, seem meagre compared with the toil expended by the nurse.
In order to handle this disease more effectively, it has been decided to practise epilation by the
Roentgen rays. A room has been set apart for a bath-room for cleansing the clothes of children, and
for medical treatment with the X-rays. An electrical apparatus for the production of Roentgen rays
is worked by current from the electric lighting mains. The special electrical apparatus comprises an
induction coil giving a 12-inch spark and a Watson's mercury turbine break or interrupter; the
dielectric being coal gas, a current of which is brought into contact with the mercury when in action.
The primary current from the main is adjusted as required by the resistance of a graduated rheostat ;
the secondary current from the induction coil passing through a vacuum tube gives origin to the X-rays.
This tube is supported by an arrangement capable of adjustment to any position and carrying a shield
so that the child patient can sit comfortably during the operation, instead of being in a constrained
position. The shield protects the patient's body from the rays and also to a certain extent protects
the operator. This protection has recently been increased. The technique is similar to that used in
the Paris ringworm schools except that the shield allows the whole head to be done in six exposures
instead of twelve as in Paris. The areas not under treatment are protected by sheet lead, the parts
under treatment being exposed by windows cut in the lead. Both the primary current from the main
passing through the coil and the secondary current going through the vacuum tube are carefully measured
and from these the necessary dose of rays can be estimated. As these factors might vary, a control
check is used in observing the chemical change in a pastille of platinocyanide of barium. This changes
from a standard green tint to a standard orange colour during the time the scalp receives the necessary
exposure, varying from 16 to 19 minutes. The action of the rays results in the hair being shed in from
two to three weeks after the exposure. In the case of ringworm, essentially a disease of the hair, the
fungus is generally carried off by this epilation. In the case of favus, however, the hair follicles also
contain spores and act as foci of disease, so that the case has to be carefully watched and any re-appearance
of the disease immediately treated. We may now look forward to practically abolishing the disease
within a comparatively short time so far as its interference with school is concerned. When the school
was started it was resolved only to keep cases till they were cured or reached the age of 14. In several
cases the parents made no effort to aid the school care, some even opposed it and children were taken
away at 14 still suffering and in two cases known the boys went to assist at barbers' shops. This has
now been remedied by the Council allowing children uncured to be retained till 16. It is highly improbable
that any child will ever be so retained as the parents at once have realised that they must
assist if their child is to be ready to leave at 14.
During the year 1908 the school had been conducted entirely on the lines already indicated.
Since May the electric installation has been at work, and during the last six months has been under the
superintendence of Dr. H. G. Critchley. The work for the year ending 31st December, 1908, may be
summarised as follows :—
In the bath-room an "Equifex" vermin destroyer has been fixed. W hile the children
are being bathed their clothes are exposed to current steam at 100°C. in the chamber of the
Equifex vermin destroyer for 15 minutes, and to dry hot air (for drying the clothes) for five
minutes, 20 minutes in all. Current steam at 100°C. has proved to be effectual in killing body
lice, fleas, bugs, and is also capable of destroying the nits of body lice which are very
resistant.