1086 THE SCHOOL MEDICAL OFFIC]4,R’S WORK.-MILK IN CARTONS.

THE SCHOOL MEDICAL OFFICER’S WORK.TIME was when the study of idiosyncrasies and j j

disease processes was the preserve of consultants iand pathologists. It was Sir JAMES MACKENZIEwho discovered how much valuable research wasopen to the general practitioner with his uniqueopportunities for clear and continued observationand his knowledge of the family history and dailylife of the patients under his care. This is true in

equal or greater degree of the school medicalservice, whose officers have the advantage of

.seeing large numbers of children so that no diffi-culty can arise in finding control groups of normalsubjects. It may come as a surprise to those whohave not studied the annual reports of the ChiefMedical Officer of the Board of Education to learnhow many qualified men and women are nowassociated with school medical work in some formor other. Although the number of senior officerswhose work is confined to schools may be small-only one county and 11 county boroughs maintaina whole-time school medical officer-yet thereare 305 school medical officers who give part timeto other branches of medical work, 984 assistantschool medical officers, 1722 additional practitionersemployed on specialist duties, bringing the totalstrength of medical and dental staff up to the

figure of 3023. There are in addition 5485 nurses

working whole or part time for the school-children.Ten years ago, Sir GEORGE NEWMAN says in hislatest report,! the school doctor had two com-plaints : first, that the routine inspection of endlesschildren was monotonous and even soul-destroying ;and second, that it was a blind-alley employment.The man who now makes these complaints knowsoften enough, he adds, that if valid these dis-abilities are his own fault. The monotony dis-appears when the wider scope appears, and the

hope of a future lies in the expansion of the

opportunity, the increased ramifications, andassociation with a more and more unified publichealth service.A faithful picture of the work done in the school

medical service may be gained from a careful

study of the reports of which regular summarieshave appeared for many years in our own columns.In one such report a county officer pointed outthat, while the best work for school-children wasbeing done by medical officers of experience, aftera term of years some of the most efficient of theseofficers became weary of routine work and left theservice for other branches of medicine, notablygeneral practice. Their interest would undoubtedlybe retained if there were a widening rangeof opportunities and interests, and, above all,encouragement to undertake original inquiries andresearch. The present report contains on pages96 to 98 a list of special inquiries and reportsmade during the year 1930, few of which unfor-tunately see the light of day. Doubtless some

proportion of this work is threshing over old stuff,but some of it reveals new and suggestive grain

1 Health of the School Child. Annual Report of the ChiefMedical Officer of the Board of Education for the Year 1930.H.M. Stat. Office. Pp. 125. 2s.

which should be winnowed for the benefit of theservice as a whole. Work of this kind is of valuein a variety of ways. It tends to keep up thestandard of local school health ; it has its applica-tion to school medicine as a whole ; more thanthat, it throws light on the normal development ofthe young of the human race, knowledge of whichis a necessary condition for any other branch ofmedical work. In the schools can be studied themanifestations which are on the borderline between

physiological variation and pathology; a linewhose determination is of no mere theoreticalinterest, for many children are condemned to

unnecessary invalidism because in the absence ofthese data the family doctor is obliged to inculcatea blind policy of safety first. In the schools themedical officer sees the earliest manifestations ofdisease such as those of mild subacute rheuma-tism ; he can study deviations from the normal,differentiating them into those due to type,idiosyncrasy, and actual disease. There is some

falling off in the present year in the variety of theinquiries, which may be explained by the extrawork thrown upon the health service by thetranster ot the tunctions ot the poor-law-good mthe long run for the additional scope-and by theobligation under the new Act to survey the housingneeds of the areas. But there should be no

relaxation in the work of the service until theentrants to school become, as with few exceptionsthey might well be, normal healthy children andremain so throughout school life ; for the servicehas long ago outlived the original reason for its

introduction-namely, to fit the children to receivebenefit from the education provided out of publicmoney-and has set itself to ensure that our

educational system shall build the whole body ofchildren strong and healthy.

MILK IN CARTONS.AT first sight it does not seem to matter whether

milk is distributed in cardboard containers or in

glass ; the main point is that it should be cleanand plentiful. Yet in fact the paper carton hasmuch to recommend it besides its amusing novelty.First and most obvious is the sound principlethat any food receptacle should be used once andthen thrown away. True, we do not apply thismaxim to our pots and pans and plates, butneither do we put these household gods outside thefront door each morning to take the chances ofthe streets. Though science may collect the bottlesdaily and sterilise them to its satisfaction thevoice of sentiment is still unquiet ; and sentimentvery often directs us towards the ideal of hygiene.So much for that ; if milk comes to the door ina carton it comes in a clean container daily andthe old one is never used again except to light thekitchen fire. But the real advantage of the paperwrapping lies in ease of transport. Bottles are soheavy and brittle that it proves expensive to sendthem over long distances ; hence they are usuallydistributed over comparatively small areas, andthe milk is not put in its containers until it reaches

1087PROF. NUTTALL’S RETIREMENT.

these areas. The milk of London, for instance, isnot, in practice, pasteurised and sealed in distantcounties where it is produced, but comes in cansto the metropolitan centres whence it is distributed.Since double pasteurisation is not permissible, itmakes this journey in the raw state, and in hotweather its bacterial count must rise considerablybefore it arrives. The alternative plan was

demonstrated to London medical officers of health z,last week when they visited the new BladenDairies near Dorchester (see p. 1108). Here themilk is collected from surrounding farms, imme-diately pasteurised, cooled, and packed in cartons.These cartons fit neatly into boxes made of

corrugated double cardboard to keep them cooland are on sale in London 24 hours after the cowwas milked.The relative advantages of pasteurisation just

after milking and pasteurisation just before

delivery are disputable, and the former methodclearly demands high technical efficiency if themilk is to be equally free from active organismswhen it reaches the consumer. With either,however, it is essential to maintain a high standardof cleanliness in the farms, and here there seems tobe some advantage in placing new organisationsin the country rather than the town. The BladenDairies at present gather milk from about 90farms within a radius of 20 miles. These farms

compete with one another to receive the higherpayment per gallon which is made to those whosemilk does best in the monthly tests of cleanliness.Lists of the successful are published in the localnewspaper, and in course of time, while the

sphere of operations will doubtless enlarge, theindividual farmer’s pride is likely to merge inlocal pride. The new organisation should thusbecome the focus of a local patriotism affecting thewhole business of cattle-rearing and milk produc-tion. Moreover, it should help to concentrate thefarmer’s attention on his proper job. One of theweaknesses of English agriculture is that the

producer, who is often trying to sell wheat, pigs,milk, beef, mutton, wool, eggs, and many other

products, cannot possibly study his markets

adequately. Difficulties of packing, transport, andeven public taste are always taking his mind awayfrom his primary task of production, and thecountryside needs centres which will receive thevarious forms of produce, handle them in largequantities, and distribute them in the quarterswhere they are needed in the form in which theywill be acceptable. An organisation like BladenDairies is making a beginning with this task of

rationalising the countryside, but if it could

enlarge its scope to comprise the grading andmarketing of eggs and fruit, for example, it wouldhave even greater possibilities for improvementof the national life.

It is a far cry from the paper carton to decen-tralisation of pasteurising plant, and furtherstill to the revival of the English dairy industry.The new method of packing has been tried before i

and abandoned, and we cannot yet say whethermore efficient manufacture and design will bring

it success this time. The problem is ultimatelyone of costs, but as has been seen, it has interestingmedical implications. What remains to be men-tioned is the possible influence of the carton in

popularising milk as a food. The new Dorset

undertaking is trying the experiment of sellingits milk in London through grocers instead ofthe ordinary dairies. Its sponsors anticipatein this way making it easy for the casual shopperto include a carton or two of milk among theother purchases which go into her basket. Theyhope that the presence of real milk on the counterwill discourage her from buying tinned or driedmilks. And by issuing small cartons, containingone-third of a pint, at a penny, they believe theywill encourage the consumption of milk by school-children. Certainly the child’s ration, at thislow price, should be attractive to many parents,though it seems doubtful whether it will show

any profit to the producers. For the rest, timealone will prove whether the sale of milk by all sortsof retailers is to be justified by results, but fromthe standpoint of public health the proposal hasmuch to recommend it. A condition we wouldmake is that the carton must be dated.

PROF. NUTTALL’S RETIREMENT.

THE retirement of Prof. G. H. F. Nuttall from theQuick Chair of Biology at Cambridge, which he heldfrom its foundation 25 years ago, has given his manyfriends and admirers the opportunity of offering himsome token of their esteem. With this object a

representative committee has been formed whichhas decided to collect a fund in order that his

portrait may be painted by some eminent artist ;a letter appealing for subscriptions to this fund willbe found on p. 1101. No doubt the response will be

large and immediate, for the services of Prof. Nuttallto preventive medicine are as eminent as his con-tributions to general biology. In 1901 he foundedthe Journal of Hygiene, and seven years laterParasitology ; ; both these journals he has editedfrom their commencement. Whilst holding the chairof biology, he obtained funds to found the MoltenoInstitute of Parasitology at Cambridge, and hastrained numerous research workers. In 1904 he was

mainly responsible for instituting a diploma intropical medicine and hygiene at Cambridge. Hisearlier contributions to medicine include the firstdemonstration (in 1886) of the bactericidal propertiesof blood-serum ; the discovery (in 1892), jointly withWelch, of the gas gangrene bacillus ; and especiallyhis classical studies on precipitins (1901-04). Hislater activities have been directed towards the roleof blood-sucking insects and other arthropods in thetransmission of disease. The study of the structureand biology of mosquitoes, lice, bugs, and ticks,which this has involved, has resulted in a series ofnoble monographs. Nuttall’s studies of endemicmalaria in Great Britain, including the distribution ofAnopheles maculipennis, were of great importanceduring the war when many cases of malaria werebeing introduced by troops returning from theMediterranean and other centres of infection. Norshould we overlook his participation in the discoveryof the specific action of trypan-blue on piroplas-mosis.