View report page

45
A number of cases of body ringworm were reported during the summer from
Ardale approved school and later in the year from Mayford approved school, and a
visit was paid to the former school by the consulting physician for skin diseases
(Dr. A. M. H. Gray). The following are extracts from his report:—
The boys were suffering from varying degrees of infection mostly confined to the groin,
but in a few cases affecting the axillae or showing small patches in other parts of the body. In
about two-thirds of the cases definite evidence of tinea infection between the toes was present,
varying from slight scaling up to a considerable eczematous reaction. Sporadic cases of tinea
cruris are generally direct infections from a pre-existing tinea of the toes, the patient infecting
himself with his own towel. Cases of tinea of the toes are almost universal in institutions
containing boys of the ages found at Ardale. Anything up to three-quarters of the boys in such
an institution may be infected. The symptoms are usually slight and it is very rarely that
anybody worries about them, although they are clearly a potential source of danger. When,
however, tinea cruris occurs in epidemic form it is almost certain that the infection is from
individual to individual and is not a case of each boy infecting himself from the toes, even though
the majority of the cases may have had toe infection for a considerable time. A source of infection
of these cases is nearly always the clothes. When the disease was first described it was called
" dhobie itch," as it was supposed to be transmitted by washermen, a view which has a good
deal to support it. The ringworm fungus responsible for this condition is extremely viable, and
will survive outside the body in scales almost indefinitely. It has been cultured from scales
a year after they have been shed. Boiling for a quarter of an hour should certainly destroy
all the fungus (Weidman has stated that the fungus is destroyed in 10 minutes at a temperature
of 48° C.), but it is possible that in some of the laundry machines the required heat does not
sufficiently penetrate the whole thickness of the clothes. Nor am I convinced that the infection
is likely to spread in baths. The ordinary swilling down of the bath or half bath by a general
flush of water almost invariably takes away any loose scales, and I know of no infection of this
kind being transmitted from the bath itself. On the other hand, there is no question that infection
of the toes is mainly transmitted from the floors of bathrooms and swimming baths, and
this risk is, of course, equally great with a shower bath, so that in some American institutions
nobody is allowed to walk barefoot on any floor and must always wear rubber shoes when in
the bathing establishments, or, alternatively, they are made to walk through an antiseptic
solution. 1 think in any case it is extremely difficult to stop the spread of toe infection in this
way, and the only reasonable line is to see that treatment is constantly applied to any infected
areas so as to prevent the spread of infecting material. It is doubtful if toe ringworm can be
entirely eradicated in such institutions, as there will always be cases in new boys and in many
cases the nails are affected. These are difficult or almost impossible to diagnose, and when
diagnosed require the most drastic treatment, such as evulsion of the nail. The disease is in
itself not a serious one, and I believe that if the cases were systematically treated infection would
die out. I note that a similar epidemic is occurring at the Mayford approved school, and I am
inclined to think that climatic factors may have enhanced the activity of the fungus that so many
of these boys harbour in their feet. If this is the case the virulence may again subside.
Dr. Gray suggests that the most effective method of dealing with the cases is
to paint each patch with Castellani's fuchsin paint. He states:—
In my experience this has many advantages over iodine and ammoniated mercury. It
is less irritating than iodine, it is in liquid form and can be painted on, which is more efficient
than rubbing in an ointment, and it has a bright colour so that it can be seen that each patch is
treated. Also in my experience it is one of the most rapid methods of curing the patches.
Open-air education
Lively interest has been shown during 1936 in methods of open-air education.
Agencies active in stimulating this renewed interest have been the London Open
Air Schools Association and the meeting of the Third International Open Air Schools
Congress at Bielefeld, Hanover (18th-23rd July).
Provision for education in the open air includes nine day open-air schools
(non-tuberculosis) with accommodation for 1,460 children, and six day open-air
schools (tuberculosis) accommodating 515 children. There are also seven country
and seaside convalescent camp schools, accommodating 520 children for periods
varying from one to three months, through which 4,337 children pass annually;
and 224 open-air classes in playgrounds and parks providing for upwards of 6,000
children.
Body
ringworm.
Provision.
D