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17
Ringworm.—This disease is comparatively common all over London. An estimate over a
considerable area showed about one-ninth of the loss of attendance due to this disease, so that in
this respect it is a very formidable item. For the individuals affected the absence from school may
be prolonged over many months, and sometimes runs into years. In many cases the absolute
neglect by the parents is such that it would be well to consider the question of a number
of ringworm classes, and after a certain time of absence compel the attendance of ringworm
cases there.
Experience has made the judgment of the nurses very accurate. In 235 doubtful cases stumps
were sent to this department for microscopical examination. The stumps are washed with ether, and
then examined microscopically in potash solution, and unless the fungus is actually seen ringworm
is not diagnosed. Over 60 per cent. of the cases thus submitted present small spored endothrix
as the common variety. Very many medical certificates are submitted in cases where the head
can scarcely have been looked at, and in others when certainly stumps had not been sought.
During the past year 51 medical certificates were so submitted in reference to cases
diagnosed as ringworm by the nurses; the fungus being found on microscopical examination in 47
cases, and in some of these cases given a clean bill of health by their doctors, the clinical
appearances were quite typical.
The anxiety of teachers to get children back to school is a matter of considerable difficulty in
so chronic a disease as some cases of ringworm—the nurse attempting to obtain exclusion from
school, whilst the teachers are striving to secure attendance again.
Favus.—Favus, which may be regarded as a variety of nearly-allied disease to ringworm,
occurs chiefly in the East End, and in a very few isolated cases in other parts. It does not seem
highly contagious, but whilst recent cases appear, under treatment, to be apparently cured, almost
every one relapses in a few weeks.
It is quite easy to miss the fungus when only a few hairs are submitted for an opinion. In
such a case the absence of the disease might be wrongly assumed, but where its presence is noted
after microscopical examination the diagnosis is positive and conclusive.
In a small district embracing about one square mile (St. George's-in-the-East, Stepney, and
Whitechapel) we know of at least 79 cases of favus. Outside this area we have also found
34 other cases.
This disease tends to spread in the family, and in the class of persons mostly affected, its cure
in a well marked case is a matter of very great difficulty. By keeping it under observation and
treatment the infectious qualities can be much lessened, and in order that education may not
suffer from prolonged school exclusion it has been decided to open an elementary school for favus
cases only. This will accommodate 80 children in two classrooms, and a separate nurse's room
will also be provided.
The question of blight and external ocular diseases comes under the work of the Oculists.
Unclean Heads.—The majority of these cases are due to vermin. Their number is
continually diminishing. Formerly many children were out of school for weeks or months
untreated, and in my first Report to the late School Board it was suggested that exclusion and
prosecution would be a good policy to adopt.
An unclean head due to vermin can be cleansed in a week, or less. The cause of the trouble is
obvious, and these cases have therefore, for the past year and a half, been used as an object lesson
in cleanliness. The nurse adopts this Cleansing Scheme in a school: she examines every child,
noting all that have verminous heads. The parents are notified by a white card, on which is also
printed directions for cleansing. Yiddish cards are used in the East End. At the end of a week,
if not cleansed, the child is made to sit separately from the rest of the class, and the School
Attendance Officer serves a more urgent warning, red card, at the home. The nurse, too, often
visits to offer advice, and then if in another week the child is still unclean, it is excluded after
having been seen by the Medical Officer, and the parent is prosecuted for not sending the child in
a fit state to school. Only an outline of the principles followed is given—the method is very
cumbersome and slow, but the results most excellent, and powers for a more rapid method of
dealing with objectionable cases are required.
The powers to be sought should be on the lines of the Glasgow Police Act, so that if a child