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102
Annual Report of the London Count,u Council 1911.
Ringworm.
Ringworm continues to be one of the plagues of school life. The first nurse appointed by the
School Board was a "ringworm nurse." In 1906 it was shown that ringworm cases corresponded to
a school absence involving a loss of fee grant of between £5,000 and £6,000 annually. This meant an
average of 2,950 children out of school. Subsequently the Attendance Department ascertained that
the average crop absent at any time was about 3,500 to 4,000. In recent years there have been about
6,000 new cases yearly. Last year there were 6,231 new cases. This was one of the diseases in which
several years ago it was pointed out that the hospitals failed to supply the public wants ; a disease
soon to become comparatively rare when public remedy is provided, as its extermination is entirely
a matter of cost. When the treatment scheme became established, an enquiry by the nurses who
filled up a card for each case, showed 3,542 cases of which 446 were being treated by Roentgen rays.
The report on ringworm in 1909 stated that "It will be interesting a year hence to determine the effect
of the organised attempt now being made by the hospitals to deal with this nuisance, as hitherto they
have failed to make any impression upon the prevalence of the disease."' Now, two years later, the
record can be continued, that the disease appears to be just as prevalent as it has been at any time
in the past half dozen years, although some effect ought to be expected shortly.
Favus, which is a more intractable disease, but of like nature to ringworm, prevailed in the
East End so that a favus school for over 80 children was opened. This produced but little effect until
radical treatment was resolved upon, Roentgen apparatus installed, and a cure insisted upon in every
case. The disease was stamped out in a few months. The record for favus for 1910 is four cases and
for 1911 also four cases. If ringworm is treated by the same assiduous method it can be almost as
readily exterminated.
At present ringworm is costing the Council not less than £7,000 per annum, in the service
of doctors, nurses and hospitals and loss of fee grant entailed, and in spite of this cost no appreciable
difference appears in its prevalence. The returns for the Michaelmas term show that of the 1,272
cases returned as cured, the average school absence amounted to 5.89 months, and in the last quarter
the average is 5.93 months. Each case of ringworm as it becomes known has a special card made
out and the school nurse follows up the case to the best of her ability. If any case is alleged to be
under treatment by doctor, it thereby passes out of consideration. Cases said to be treated by a
chemist or at home are offered X-ray treatment, but if refused no action is taken. This is the weak
part of the scheme. Certain other cases are, however, followed up and treated under the Council's
schemes. About 20 per cent, now coming under treatment are by Roentgen rays. So far, up to the
end of 1911, there is, however, no noticeable diminution in the number of cases being reported.
The nurses are most assiduous, and the laboratory renders all certainty possible in the diagnosis
of cases. The certificates of medical men in regard to the ringworm specimens received at the laboratory
are not now enumerated, as considerably over 90 per cent, were erroneous. During the year, 6,231
fresh cases have been reported. Of doubtful cases, in which specimens were submitted for microscopic
examination, 2,926 specimens were examined. The ringworm fungus of various varieties was
detected in 2.165. favus in 4. and no funcrus could be found in 757 cases.

The only drawback to the radical treatment of ringworm is that it would have to be considered
as a public nuisance, and every case compelled to be cured within a reasonable time. Further, it is
so prevalent that the private schools or other educational institutions, not under oversight of the
Council, or indeed any sanitary authority, might still keep up reinfection of the child population.
Otherwise the disease can be rapidly made to disappear, and its present cost to the Council indirectly
is so great that it would probably, on financial grounds alone, be justified in spending even £10,000
a year for several years in stamping out the disorder, although the cost required would not nearly
reach this figure.
Open-air
schools.
The experimental open-air schools on the model of the Wald Schule of Germany have been fully
described in previous reports. Two open-air schools were continued at Birley House and Shooter'shill
(Shrewsbury House). They were opened in April, and during the first few days the weather was
exceptionally severe, the temperature running between 40 deg. F. and 50 deg. F. during the day, and
several degrees of frost being registered at night. In spite of the inclement weather the school was
carried on as usual, the children taking refuge in the Doecker shed during the blizzards of snow, and
although most of the children came from homes with stuffy atmosphere and where closed windows are
the rule, none of them suffered any harm from the unusual conditions of their schooling. Some