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In my early naval days I belonged for some years to a fast-sailing wooden frigate in a squadron of similar vessels, the speed of which was, of course, regulated by that of the slowest ship, and she was a very slow ship indeed, always hull down, with every sail set, trying to catch the leading clipper which, with shortened sail, hung restively compelled to curb her progress. When within a few days of port it was customary for the admiral to make the signal to proceed independently. With what joy did we seize the opportunity of cracking on all sail and showing the squadron a clean pair of heels. The thought has often struck one what advantage might be gained, could a similar signal be made in elementary school education, if the timeworn conventions which still chain the progress of the able pupil and permit him to advance only at the pace of the most backward, could frankly be discarded. How such a signal would be hailed, since it would spell freedom for those hitherto fettered by the rate of the “ Dummy Ship.” Who knows what results might ensue once given the chance of independent Alight? Every capable boy in workshops such as those of the Mars may, with very little assistance, rise to proficiency as carpenter, elementary metal-worker, blacksmith, ropemaker and sailmaker, and the like, self-respect growing as each new trade is learnt. And what of the “ Dummy Ship”? Can we not do something to improve her rate of sailing? The following may partly serve as answer. A few years ago a mentally deficient boy was accidentally admitted to the Mars. The only way of getting rid of him would have been by transference to a centre for mentally defective cases, a course which did not seem open to us. As it was useless to put him in the schoolroom, he was permanently placed in the workshop, where he proved useful as a sweeper, and in other practical, although humble, occupations. One day the instructor and I were examining a section of a tree trunk some hundreds of years old, and I happened to mention a method (suggested in 0. W. Holmes's “Autocrat of the Breakfast Table '') of teaching history by marking dates on the annual rings of
"Geordie" chanced to be standing near, and turning round suddenly, I was struck by a gleam of intelligence in his eyes, as though the idea had partially penetrated. After this encouraging sign greater pains were taken with the lad. He developed into a fair carpenter, and though he will never be able to read or write, the Mars workshops have secured him not only escape from a death-in-life existence, but open for him a useful and contented future.
No one would dream at this moment of saying one school has
distinguished itself beyond any other during the War, but it is only fair to place on record the frequent testimony as to the outstanding efficiency and smartness of the Mars boy as compared with the average recruit. The steady discipline of years and hardy service training result in instant response to the requirements of the drill sergeant. The ready hand and eye, disciplined by constant practice in manifold use of tools, have proved beyond question the preparedness of such a youth for all the various demands of camp and field. The advantage of not having specialized enables the Mars boy to adapt himself to whatever trade or career fate may hold in store, for his foundations are sure.
The existence of the so-called Home Office Training Ships, of which the Mars is one, has been completely justified by the way in which their former inmates have taken up service afloat during the War, particularly in patrol vessels, armed trawlers, and mine sweepers, work for which their boating experience in boyhood has admirably adapted them. So valuable must their assistance have been that it invites the reflection that every stay-at-home man in the country should mark his appreciation of those who hold the "narrow seas which keep her off” by educating himself in nautical matters generally, as well as by paying due respect to every member, however humble, of our sea service, and also by trying to improve the condition and prospects of its personnel in time of peace. The establishment of nautical continuation classes in Board Schools throughout the country would be a practical step in this direction. “Mars” Training Ship,
THE MANAGEMENT OF RINGWORM IN CHILDREN.
By John PRIESTLEY. Senior School Medical Inspector, Staffordshire. It is curious to note what intense loathing and dread the name ringworm excites. You may have impetigo, and nobody winces, but at the mention of ringworm women pluck their skirts about them and strong men clench their hands in despair. Perhaps it is because of the unfortunate name : we might have borne T'inea tonsurans with: greater equanimity. And yet ringworm never killed a single child, and it might almost be added that, apart from its treatment, it never caused an hour's suffering. Moreover, it infallibly gets well in time, even when little or nothing is done for it, and in most cases the cure occurs in a comparatively short time. Nor is ringworm violently infective or frequently epidemic; it exhibits these anti-social qualities in quite a moderate degree. It must be admitted that it is chiefly in towns that animosity to ringworm rises so high. In the country there is a saner appreciation. Perhaps the observation of ringworm in cattle has a reassuring effect.
Before the days of systematic medical inspection of schools our knowledge of ringworm suffered from a faulty perspective. The bad cases for obvious reasons loomed large and disturbed our judgment. It is possible now to present a truer general account. Ringworm should be compared with impetigo, the disease frequently seen among ill-tended children and characterized by heavy, dirty yellow incrustations, for the two ailments are curiously alike in essential points. Their prevalence at school infections, in Staffordshire schools at any rate, has not been very dissimilar, taking one year with another during the period of medical inspection; they are about equally infective, and they are always to be found in the county. They generally appear sporadically as single cases or in tiny groups of two or three, but occasionally both diseases—as a somewhat rare event and under conditions which are not at all clear-may become suddenly epidemic in a school. The epidemics as a rule cease as suddenly and unexpectedly as they arise, and in such a manner that I at least am not always convinced that our measures have routed them. Speaking quite roughly, on any day of the year you will find ringworm present in the elementary school administrative area of Staffordshire in about half the number of schools. The actual figures for 1912-14 show a yearly average of 166 schools out of 375. In by far the larger number of these 166 schools ringworm was present in single cases or in quite small groups;
; it did not spread, and by no stretch of courtesy could the disease be called epidemic. At the very outside there were only twelve schools on an average each year to which the term epidemic could be rightly applied-that is, about 7 per cent. of the schools affected.
The infectivity of ringworm is low, and very intimate contact seems to be necessary to spread the disease. Again and again it appeared that it was not so much among the children sitting together in school as among the children living in the same house or the same street that the cases were found. Infectivity is not easy to estimate, but we may do so relatively by comparing the number of cases of the infectious disease found at an inspection with the total number of children of about the same age, and therefore attending the same classes and mixing freely with one another. If we had the figures for such a disease as measles we should undoubtedly find them very high. When the method is applied to pediculosis, or the infection of lice, we find that 29 out of every 100 children associated in the same classes are infected, whereas in the case of ringworm there are only five or six children out of 100. The numbers for impetigo are very similar to those of ringworm.
All these cases of ringworm must get well before the age of 15 or 16, since the common form of ringworm found in schools is almost unknown after that age. Moreover, there is a progressive decline in the prevalence of ringworm with years; there are about twice as many cases among children of 5–6 as among children of 8–9, and about twice as many cases among these children as among those of 12—13. This natural decline must never be forgotten in judging of the effect of remedies.
What, now, is the therapeutic effect of the so-called remedies ? The matter seems very simple. The mould or fungus of ringworm is in reality a very vulnerable organism; it can be killed by many simple chemical solutions if only they can get at it. Even soap and water is a good remedy when the fungus lies on the surface; if it does not instantly kill, it detaches and washes the parasite away. But unfortunately the fungus creeps into the deep hair follicles of the scalp, and there it is often safe even from the penetrating tincture of iodine so long as the root of the hair remains as a stopper to the follicle.
Herein lies the secret of the X-ray treatment. X-rays cause wholesale epilation, and in falling out the hair drags with it most of the
fungus. What is left is easily dealt with by the antiseptic ointments and tinctures subsequently applied. But the whole process is very like burning down the house in order to roast the pig. X-ray treatment is no doubt efficacious in scalp ringworm. It seems also to be fairly safe, although permanent baldness has been caused and injury to the brain has on theoretical grounds been dreaded. But whether, considering the low infèctivity of ringworm, its small tendency to become epidemic, and its essential harmlessness, X-ray treatment is strictly necessary in any but a few very bad cases is open to debate. We want to know what is the average duration of untreated ringworm, and the following figures may perhaps be taken to suggest it :
Although there are few of our Staffordshire cases which are treated scientifically from beginning to end under a doctor's eye, there are extremely few which go literally untreated. Most mothers know of something to do for it, or if not their friends and neighbours do. Ink, tobacco-ash and water, “bluestone” (i.e., copper sulphate),
' “what we use for the calves,” all have believers, while Jeyes' fluid, white precipitate ointment, sulphur ointment, &c., are popularly known and used. But it may be accepted that scarcely any treatment is persistent, and considering the extremely obstinate nature of some cases of ringworm which go on for months and even years, in spite of the most steady and scientific local treatment, it is safe to say that the main characteristics of the treatment of the following group of cases was inadequacy. No X-ray cases are included; in extremely few would the local drug treatment be both scientific and adequate, and in the great majority of cases the treatment would be wellintentioned, indeed, but discontinuous and distinctly inadequate according to a hospital standard.
On analysing our returns I find there were 778 cases of scalp ringworm; about 20 per cent. of them got well within three months, about 50 per cent. within six months, and nearly 80 per cent. were well by the end of the first year. By the end of the second year 95 per cent. of the cases were over. There were then left 37 cases : 27 of these got well during the third year, 7 during the fourth, and 3 during the fifth. Taking all these cases together, the average duration was nine months, the minimum being one month and the maximum fiftyeight months.
It must not be supposed that the longest cases were the untreated ones—far from it. The writer remembers a
case many years ago assiduously treated under his own supervision, which lasted three