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87
proved by overwhelming evidence. Thus, if a primary case of
measles were discovered in a class of susceptible children on, say,
January 1st and were isolated after one session's attendance at
school, one would find that secondary cases would occur between
January 9th and 14th (i.e. during a period corresponding to the
known incubation of the disease assuming that infection was acquired
on January 1st). What one does not find are cases witnonsets
from January 14th to 20th, as one would do if a measles
child infected the walls and floors. In other words one must seek
to control measles on the assumption that it spreads from the sick
to the healthy, and not through the medium of infected plaster and
boards.
Similar remarks apply to diphtheria of the throat, which happily
has a more limited power of spread because it is not commonly accompanied
by a cough to mechanically expel infection into the
atmosphere. Nasal diphtheria is somewhat more liable to diffuse,
because infected secretions can more readily be conveyed from the
sick to the healthy.
It may, I think, be affirmed of these diseases, which are typical
of school epidemics:—
(1) That infection nearly always spreads in the direct way
just described.
(2) That, occasionally, infection may be transferred by the
medium of clothing, pencils, handkerchiefs and so forth.
(3) That whatever infection reaches the floors and desks is
so small in amount that it can be rendered innocuous by
attention to the ordinary rules of cleanliness, and by free
ventilation.
A'e I would therefore deprecate resort to routine disinfection, firstly
because there is no evidence that it is necessary, and secondlv
because it would be likely to absorb attention and money that can
be spent more profitably in securing greater use of soap and water,
and more thorough perflation of class-rooms.
If the healthiness of school buildings is to be increased, there is
no doubt that attention should be concentrated on obtaining more
thorough ventilation, and more frequent washing of floors, desks,
and walls. In order to facilitate the latter operation in future
schools it would be an advantage if one of the jointless impermeable
floors were substituted for wood blocks and boards. The desks and
seats should also be fixed with standards so arranged as not to
afford lodgment for dust and interfere with the free use of swabs and