2
391 . view has been to increase the isolation of the infant in hospital to the point of solitary confinement. To prevent cross-infection infants are walled off in cubicles, packed away’in glass cases, and attended (with the minimum of handling) by robed, masked, hooded, scrubbed nurses and doctors who move cautiously and speak low so as to keep down the bacteria in the air. Such protected nursing is ideal for the acutely ill patient (the infant having a Rammstedt’s operation, for example) who is likely to stay only a week or two in hospital; but it is sometimes mistakenly continued long after the child should have joined the others in the main ward : an acute illness may become chronic and so may life in a cubicle. The young child’s mind is feeding on experience; at no period of its life will it again have such blotting- paper facility for picking up impressions. It is only necessary to think successively of the newborn foetus encountering its first breath, and the competent, lively, curiosity-ridden yearling, already striving after speech and an upright gait, to see how much solid learning is packed into the first twelve months. Life in a cubicle is experience of a kind, no doubt, but experience so boring that the grossly understimulated occupant may go back instead of forward; he even ceases to respond to the things which normally please him. Bakwin finds that some infants go further-they lose weight and become prey to chronic infections. Respiratory catarrhs which last a day or two at home may, he says, persist for months in hospital ; with mistaken kindness the house-physician judges that the child is not fit enough to go out, whereas he is really not fit enough to stay in. A return to the care of the mother and the normal experiences of home life may have a startling effect ; Bakwin publishes photographs of children for whom discharge from hospital has certainly been a godsend. As a result of this belief medical officers at the Bellevue Hospital have been encouraged of late years to play with and lift the children, and parents of sick infants are invited into the wards and told to pick the baby up. No doubt more handling increases the risk of cross-infection ; a reflected rise in infant mortality might be expected, but in actual fact the case-fatality rate at Bellevue, after being steady at 30-35% up to 1929, has fallen since and is now below 10%. Bakwin does not suggest that the freer handling of children has made this difference, of course ; many factors have been at work. But it is clear that more mothering has not meant a corresponding increase in deaths. A GREAT SPANISH SURGEON MANUEL CORACHAN, who has died in Barcelona at the age of sixty-two, was one of the most distinguished Spanish surgeons of our time and the outstanding personality of the Catalan school of surgery. He was a victim of the epidemic of typhus which it seems is still spreading to new parts of the Peninsula. Corachan had been a pupil of Ribas-Ribas and if in activity and enterprise he was the equal of his teacher, he was his superior in skill and manual dexterity. Besides being an honorary member of many continental surgical. societies, the founder of the Spanish Association of Surgeons, founder and one of the presidents of the Catalan Surgical Society, he found time to write an impressive number of papers and several books. Among the latter are two volumes on gastric surgery-probably the most complete work on that subject in Spanish- his work on arthroplasty, and his remarkable contribu- tion to the technique of and indications for arteriography, an important complement to the pioneer work of the Portuguese school of Moniz and Dos Santos. The sufferings of the Spanish War fell upon Corachan in full measure. His - eldest son, a very promising brain surgeon, was killed at the front, and Corachan himself was obliged to live in exile until recently when he was allowed to return to Spain. During his years of exile he received an invitation from the university of Caracas, Venezuela, where he was appointed professor and director of the Institute of Experimental Surgery ; a number of works, some of them of interest, were published there under his guidance. He was loved by his students and by all who came in contact with him for his modesty and sincerity. With his passing has gone one of the most brilliant surgeons that the Peninsula has ever produced and his death will be deeply mourned, particularly in his own country and in Latin America. MEASLES AND ULTRA-VIOLET LIGHT THE annual report of the Commonwealth Fund differs from many of its compeers in being easy to read : an some of the best stories in it are to be found in the " sketches from the field." The 1941 report tells of an experiment carried out by W. F. and M. W. Wells, of the laboratories for the study of air-borne infection at the University of Pennsylvania. These workers-who, with T. S. Wilder, have reported their findings fully elsewhere 1 -have evidence that ultraviolet lamps kept constantly burning in school classrooms (not directly exposing the children but producing an irradiated ceiling check the spread of measles and possibly also of chickenpox and mumps. The 1940 measles epidemic in Philadelphia was the largest on record, but it seems to have been checked by this method in 22 classrooms in Germantown in the city and Swarthmore just outside it. The lamps were first installed in 1937, to decide whether epidemic infection could be controlled by radiant disinfection of the air. In the Germantown Friends School records of illness showed which children could be presumed to be immune from measles, thanks to a previous attack, and which were probably susceptible. Histories of previous attacks are not usually very reliable, but they would probably be accurate enough to give the figure a bias an the right direction. - Records of illness were kept throughout the investigation. In the first three years of the experiment there were no striking episodes except an encouraging result in a small outbreak of chickenpox. In October, 1940, however, measles became widespread in Philadelphia and the school records showed that the Germantown children were ripe for an outbreak-during the three years of observation susceptibles had risen from 12% to 23% among the senior children, from 26% to 49 % in the intermediate grades, and among the junior children, who had the lamps in their classrooms, from 62% to 75%. By the end ofthe epidemic 88 of the 141 susceptible senior and intermediate pupils (taught- in non-irradiated classrooms) had taken the infection, while only.24 of the 110 susceptible children in the junior grades had gone down with it. It turned out that 10 of the older children and 8 of the junior children had caught their measles at home, so that 55% of the 141 children in older groups and 14’5% of the junior children had been infected in school. The same pattern was found in the Swarthmore schools. Among 191 suscept- ible children in the younger grades, using irradiated classrooms, there were 47 cases, the attack-rate being 13% when cases of measles caught at home were ex- cluded ; among 137 susceptible children in the senior grades, not protected by lamps, the attack-rate was 52 %. The unusual distribution between seniors and juniors might, of course, have been due to some peculiarity of the virus or to greater susceptibility among the seniors, and not to the lamps at all ; but there was no such reversal of age-incidence in Philadelphia as a whole. Moreover, though no control experiments were made, a neighbour- ing school in Germantown offered some figures for comparison-among 95 boys in the junior grades (susceptibility unknown) the attack-rate was 50% and among 391 in the senior classes the rate was 10%. In the experimental schools comparable figures are obtained by working out the attack-rates for the classes as a whole, susceptible and non-susceptible together. Thus at the 1. Amer. J. Hyg. 1942, 35, 97.
