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SCHOOL CLOSURE FOR INFECTIOUSDISEASE.

FROM time to time the parents of children away atboarding schools are agitated by the intimationthat infectious disease has occurred at the school,and that in consequence the school will be closedbefore the date on which the term should end. Nodoubt in individual and exceptional instances such aprecaution as school closure may prove to be thesmaller of two evils. We doubt, however, whetherthe occasions for its application are nearly as frequentas headmasters, through their own anxiety or throughthe cautious counsels of their medical advisers, wouldlead us to believe.

" " , , ,., " .., IThe experience of the school medical service of this

country appears steadily to be crystallising in a formopposed to the use of school closure as an instrument tfor the control of infectious disease. The argumentswhich apply to the procedure in its relation to thepublic elementary schools, both urban and rural, inthis country seem to have special point in respect ofboarding schools. The closure of the school involves

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a general dispersal of the occupants to families orcommunities, in many of which they will not be underany degree of careful supervision ; the one originalfocus of infection may thus multiply itself in a numberof different localities. Had the school been kept open,and had the daily medical and nursing supervisionbeen adequate, each fresh case as it arose could, inmost of the infectious diseases, have been detectedat a stage before infectiousness had developed to amaterial degree. Moreover-and this is an aspectwhich appeals to the long-suffering parent, though heaccepts the prevailing practice with singularly littlegrumbling-the child would receive the term’s schoolingcontracted for and paid for, but only in part receivedunder conditions of premature closure. Undoubtedlythe present practice is based, not on closure as a truemeans of controlling infectious disease, but on thelack of pains taken in many boarding schools toevolve an effective machinery for the daily super-vision of the health of the pupils. The happy-go-lucky attitude which enters so much into the spiritof the recreations of the boarding school permeatesthe attitude of the principal and of the staff towardsthe physical health of the inmates. Probably quite asmall proportion of the masters have any knowledgeof the symptoms and signs of infectious disease

approaching that acquired by the elementary schoolteacher, while the school nurse, with a thoroughgrounding in infectious disease, who is so closelylinked up with the public elementary school, is, onthe whole, distinctly more expert in this subjectthan is the average matron at a boarding school.We believe that some degree of concentration onthis aspect of the control of infectious disease inresidential schools would result in a material drop in (the frequency of premature closure. EBut while the experience of school medical officers 1

in the service of local authorities is in general increas-ingly unfavourable to closure as a preventive measure

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against the spread of disease, it must be confessed athat their practice does not always march with their rjprecept. It is not uncommon for school medical

aofficers to advise closure of an elementary school;department on account of infectious disease when the tattendance drops to a low level-perhaps in theneighbourhood of 50 per cent. of the normal-such rrclosure being largely for the convenience of the educa- Ttion authority, and to save loss of grant from the rf

Treasurv on account of low attendance rather thanbecause the medical officer has any faith in closure t ’

as a means of controlling the outbreak. It needssomething of the casuist to draw any clear distinctionbetween the school medical officer acting on such abasis and the headmaster of a boarding school whocloses his school on account of infectious disease.Is there not scope for both to review their methodsand to define the procedure which will make for thegreatest good of the children under their supervision ?

TUBERCULOSIS OF THE LARYNX.THE Medical Research Council has just published 1

an instructive account by Sir STCLAIR THOMSONof his experience of laryngeal tuberculosis at the

King Edward VII. Sanatorium at Midhurst over aperiod of ten years. During this period 2541 cases

of pulmonary tuberculosis were admitted, andamong them were 477 cases of tuberculous invasionof the larynx. The author adopted the happymethod of passing all his case-cards and notes to anindependent worker, Dr. D. A. HUTCHESON, whocompiled the figures, tables, and averages withoutany suggestion from anyone as to the conclusionswhich might be anticipated, thus avoiding to a verygreat extent the personal bias inevitable in all humanundertakings. The conclusions to be drawn from thestatistics thus analysed do not, as a whole, differgreatly from the many similar figures which havepreviously been compiled. In one respect, however,there is a marked difference ; while numerous tablescompiled up to ten years ago show that laryngeal’invasion was two to three times more common inmen than in women, the Midhurst figures make theincidence almost exactly equal. Sir STCLAIR THOMSONpoints out that most of the women admitted toMidhurst are wage-earners who follow the same, orsimilar, employments as the men-viz., clerks, typists,teachers, &c.-and concludes that any increasedsusceptibility of the male is due to social, and not tosexual, differences. Before 1905 the post-mortemrecords at the Brompton Hospital showed twice asmany cases of tuberculous laryngitis in men as inwomen, but since 1908 the proportion has been almostidentical ; the question arises, is this the result ofthe change of habits and occupation among women ?For the last five years of this investigation, involving1456 patients, notes were made of the conditionof the nares and pharynx ; the conclusion is thataffections of this region are no more common inthose with laryngeal invasion than in those whosedisease is limited to the lungs ; also, though it wouldbe difficult to make a comparison of the nose andpharynx in sanatorium patients with an equal number)f the healthy public, the author’s impression is thatrouble in these regions is no more common in aianatorium than out of it. Three cases of intrinsic;ancer in phthisical patients provide interesting’xamples of the difficulty of differential diagnosis.Fhe author concludes that epithelioma of a vocaliord is a very slow-growing tumour ; if it is so limited,s to be difficult to recognise, a delay of two or threenonths in clearing up the diagnosis can do little harm.’here is also a unique case of aspergillosis of the lungsnd larynx, the latter presenting a typical picture ofuberculosis ; recovery was rapid under sanatoriumreatment.So much for the pathology of laryngeal tuberculosis.

’he chief feature, and the great value, of Sir STCLAIR’HOMSON’s report lies in the emphasis laid on the3markable benefit which the tuberculous larynx1 Special Report Series, No. 83. H.M. Stationery Office. 2s. 6d.