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in the provision for medical treatment, an increase which is still going on. In
January, 1910, arrangements were made with seven hospitals for the treatment
of 12,700 children, in 1912 there were in addition three ad hoc " treatment centres;"
there are now (in 1925) 73 hospitals and treatment centres in the scheme, providing
for the treatment of 254,000 ailments of children annually, including 120,000
children dentally treated. It is impossible here to recount all the various
activities which have been undertaken during this time for the improvement of
the health of the children, in growth of provision for physical exercises and games,
school camps, open-air education, convalescent treatment, and the great increase
in sight-saving classes, of which there were 5 in 1914 and 26 in 1925.
The result of all these manifold activities for the benefit of the school child is
shown in improved physique and health. Some forms of uncleanliness, such as body
vermin, have practically disappeared, others are very greatly reduced. The condition
of the children's teeth on leaving school has greatly improved, and is still improving.
It is recorded in the minutes for 1898 of the School Board for London that 80 per
cent of pupil teachers were found, on medical examination, to require dental
treatment. In 1925 the percentage of scholarship holders found to require dental
treatment was 7 per cent. The interest taken by the parents in the medical and
dental inspections of their children is very great. Over 80 per cent, attend at one
inspection or other of the school child. The bringing into consultation, of the parent
with the doctor and the dentist, on this immense scale has a huge propaganda value
for public health.
Turning now to Dr. Niven's second special influence for good, the control of
infectious disease. Here, while attaching great value (and of course London
experience is emphatically with him) to efficient disinfection and to hospital
isolation, he laid stress also on the importance of "a good system of investigation
of disease." Shirley Murphy would undoubtedly have endorsed this and he, in
fact, established a tradition in accordance therewith from the very outset. The
medical and inspectorial staff of the public health department (as Dr. Niven testifies
was the case in Manchester also) entered with zest into, and was carefully trained
for, this most essential work. Again and again "the chief " would insist upon
proving all things, exploring all the possibilities, at whatever cost of time and
trouble. The well equipped enquirer of to-day, with many novel means of investigation
at his disposal, is sometimes tempted, perchance, to jump to conclusions ;
if not, indeed, to regard as somewhat old fashioned the dull routine of methodically
testing all observations and hypotheses regarding causation of disease by study,
not only of the phenomena presented by actual sufferers, but also of those yielded
by a " control population." This "control work " was, ab initio, always rigorously
insisted upon and loyally and unwearyingly carried out; thus, over and over
again, it was found in practice possible to avoid too ready acceptance, or unwarranted
use, of what the event might show to be an inappropriate method of administrative
procedure. Furthermore, it was recognised throughout that the essential
condition of success in London (where jurisdictions perhaps have been even more
divided than in Manchester) was to be sought in the closest possible co-operation
with the staffs of the borough councils, with those of the hospitals of the Metropolitan
Asylums Board, of voluntary hospitals, of poor law institutions, and last, but not
least, with the general practitioner.
Both Shirley Murphy and Niven, despite their extreme caution, were ever alert
to make use of any extension of knowledge utilisable for preventing spread of epidemic
disease. From the beginning they were alive to the danger of "mild" and "overlooked
" cases. Shirley Murphy studied with keen interest, in the early years of
this century, Koch's campaign against typhoid fever in south-west Germany, and
the experiments made in this country and abroad in connection with isolation of
healthy carriers of diphtheria and typhoid bacilli. He realised, however, from the