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19
PULMONARY TUBERCULOSIS AMONG SCHOOL CHILDREN.
In a paper published in " Tuberculosis" some half-dozen years ago reasons were given for supposing
pulmonary tuberculosis at school ages to be quite insignificant in amount, but there have not been
wanting alarmist reports as to the prevalence of this disease among children.
It became a matter of serious importance not to obtain statistics, but to ascertain how far children
at school ages were affected, and how far they might be a danger to others. Our rule for some years
has been that where a child has been supposed to have consumption it must be excluded from school
if it coughs or spits. Teachers in any way affected with pulmonary tuberculosis are excluded from
school for at least twelve months. The risks of infection from cases obviously suffering are therefore
small.
Further, the invalid schools remove many tubercular children, with bone or joint diseases, and
some doubtful cases of pulmonary disease. There are, however, undoubtedly many cases of tubercular
children in the schools who are practically not infective, and not likely to become so. On the other
hand, cases are met with in hospital out-patient rooms who have been out of school for periods measured
by years, on account of " consumption " who have no sign of disease about them. And cases are sometimes
reported to us and medical examinations requested by managers of children said to have consumption,
but who are often found in good health.
An enquiry has therefore been carried out during the past year in schools of Fulham, Hammersmith,
Kensington and Marylebone by Dr. J. E. Squire and Dr. Annie Gowdey. An attempt was first
made to ascertain how far children attending school were popularly supposed by their parents or the
teachers to have consumption or other forms of tuberculosis.

This preliminary enquiry was not expected to furnish other than a popular idea of the prevalence
of disease. It was evident on dealing with the returns that they were unreliable. As a matter of fact,
cases reported as having " consumption " were free from it, and in the cases where it was found it had
not been suspected.
In the case of hospital patients watched through a long period Dr. Squire notes that many with
pathological enlargement of tonsils or adenoids often show indefinite signs in the lungs, patchy dulness,
tubular breathing and crepitations, which suggest that they may be going to develop phthisis, but
completely clear up after a time and are probably due to atelectasis. My own experience is that
two out of every three cases of non-attendance where " consumption " is assigned as the cause are beat
treated surgically, and the majority of such cases, even with coughs, treated assiduously with cod liver
oil, and often swathed in flannels are flabby children, often of somewhat better class parents, suffering
from adenoids. In this examination one child was found with eight, another with six flannel garments.
Most of the cases classed here as doubtful appear to have been cases with evanescent pulmonary
signs. The two schools selected for individual examinations were Latimer-road, the one returning
the greatest number of consumption cases, and a neighbouring school where the children were of a somewhat
better social type. Examination was in some cases refused, but in the case of Latimer-road Boys
all but 2 of the 335 were examined. The children were weighed and measured ; the condition of clothing,
cleanliness and nutrition noted ; the teeth, throat, neck, and ears examined, and the chest carefullv
examined without clothing, a card being filled up for every child seen.
Dr. Squire examined the boys, Miss Gowdey the girls, and all cases with any abnormality
were seen by both the doctors.
14958 C 2