543

of the use of bacteriology as a preventive measure in

relation to disease, the prevention of syphilis as a nationalevil, the housing question, and the securing of the necessarypowers and funds to carry out the requirements in respect ofthe foregoing matters and all other questions relating topublic health. An executive committee was appointed withpower to arrange for the conference in question to beheld in London in October or early in the winter andto invite representatives from Scotland and Ireland to theconference. We gave our support to this scheme at its

inception as a definite endeavour to promote the estab-lishment of a properly organised public health service

such as in other countries is represented in the Cabinet.The recognition of the aims of the conference by speedylegislation does not appear to us to be very probable, butthe thanks of the community will be due to those who aresucceeding in making a public question of a national healthauthority. We consider that the present cooperation is

setting to work in the right way to win notice in the properquarters.

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THE DIRTY WATER-BOTTLE.

IN places of refreshment a clean sparkling water-bottle Iis rarely the rule. The glass is usually filmy instead ofbright and often presents an appearance distasteful to

cleanly sentiment. It has even been suggested that there isa definite design in exhibiting on refreshment bars water-bottles net scrupulously clean, the idea being that the cus-tomer may be induced to order a bottle of mineral waterinstead of slaking his thirst gratuitously. Dirt is nearlyalways the evidence of things unseen in the shape of micro-organisms, and the public have a right to expect the watersupplied to them to be in a fit condition for drinking. We gofurther and suggest that our health authorities might occa-sionally organise a system of inspection and examination of thewater used for drinking purposes at railway bars, restaurants,public-houses, and other places of refreshment, and inflicta wholesome penalty on the caterer who keeps the water-bottle and the water in it in a dirty condition. It should be

remembered that though, on the whole, the water-suppliesin most towns are good, yet they are rarely sterile, and micro-organisms accumulate in great numbers on the depositwhich sooner or later is thrown down from the water keptstagnant in a bottle. The dirty water-bottle is an offenceagainst clean, healthy principles which require no scien-

tific refinements to establish them. Then let scrupulouslyclean water in scrupulously clean containers be insisted uponeverywhere.

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MEDICAL EXAMINATION OF PUBLIC SCHOOLBOYS.

Mucn has been written as to the necessity for a proper Imedical examination of children attending public elementaryschools, and there seems at last some likelihood that pro-vision for such needs may be made by Parliament. A similarexamination of the boys who enter at our large public schoolsmay not at first sight appear so indispensable, inasmuch asthey are drawn from the richer classes, and not only shouldthey be presumably free from many disorders resulting fromunwise or defective feeding, but any physical defects shouldbe already well known to their parents who can afford con-stant medical supervision. The inquiry carried out by Dr.Clement Dukes, an account of which appears in another

column, shows that this presumption is scarcely borneout by the facts. It is certainly surprising to find thatdeformities resulting from past rickets may be common

among boys who enter at our public schools. Thus of1000 boys examined, ranging chiefly between the ages of13 and 15 years, no less than 445 presented lateral curvatureof the spine and 526 had knock-knees, while pigeon-breast wasobserved in 126. Flat-foot, not necessarily a rickety defect,

was found in 329. Dr. Dukes attributes the existence ofrickets among the wealthier classes to failure of the mothersto suckle their children and to the resulting use of patentfoods deficient in nourishing qualities. Another point ofinterest in Dr. Dukes’s paper which may here be alluded tois the association of adolescent albuminuria with chilblains.Both maladies are, we believe, benefited by treatment withcalcium salts and may depend on the same vascular condi-tion, It is gratifying to find that Dr. Dukes does not attachany serious pathological importance to this form of albu-minuria and deprecates any serious restrictions on a boy’spursuits on its account.

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MEDICAL INSPECTION OF SCHOOL CHILDRENIN BULGARIA.

ADDRESSING one of the sections of the recent International

Congress of School Hygiene, Mrs. Watt Smyth, the authorof that excellent book " Hygiene Based on Physiology forSchool Teachers," said that she had just returned fromBulgaria where, through the courtesy of the Government,she had been allowed to make a study of the school

systems prevailing in the different parts of the country.As a result she was particularly struck by the excellenceof the system of medical inspection of secondaryschools, introduced by M. le Docteur Schichmanof,Minister of Public Instruction. The system has been

actually in force for four years and might be copiedwith advantage in England. The history of Bulgariamakes this particularly interesting inasmuch as a genera-tion has not yet passed since that country had achievedits independence. Education, Mrs. Watt Smyth said, wasmade compulsory in 1879 and it was significant thatwhereas 25 years ago of the recruits of the Bulgarian armyonly 10 or 12 per cent. could read or write, now 97 percent. could both read and write, the 3 per cent. being ofother nationalities. Mrs. Watt Smyth wished to make it

quite clear that in all the secondary schools a medical

practitioner, who in the case of girls’ schools was a lady,attended every day for as many hours as was neces-

sary. It appears from her observations that a well-equippedconsulting-room is provided in each school building with allthe appliances necessary for the examination of scholars.A separate health note-book is kept by the medical ’Iinspector for each child during its school life. Onfirst admission the scholar is examined undressed andentries made of weight, height, chest measurement at

rest and in full inspiration, vital co-efficient, muscular

force, and physical defects. The sight and hearing are

tested and the teeth examined, the general conditionis considered, and the health of the parents and thediseases from which the child had suffered are entered.This examination is repeated twice a year in the upperand three or four times a year for the lower standards.If at this examination a child is found to be sickly, ill-

developed, or suffering from definite disease, the parentsare communicated with and the child is given leave ofabsence for treatment by the family medical attendant.The school medical officer visits the class-rooms and ifa child is ill for more than one day he is sent homeand not again admitted without a certificate signed byhis family medical attendent and countersigned by theschool medical officer. The latter keeps a special listof scholars suffering from any serious disorders, such asheart disease, and watched them carefully. It is interest-

ing to note that during the past three years in the girls’secondary schools at Sofia no case of infectious diseasefrom among the day scholars has got further than themedical officer’s consulting-room and there has been no

case among the boarders. The medical officer has the power

1 THE LANCET, Oct. 21st, 1905, p. 1187.