241PUBLIC HEALTH

committee thinks it of the greatest importance tomaintain the machinery of the sweepstakes in existencetill better times come, and therefore they hope to beable to continue the series at any rate throughout 1941.The total sum which has accrued to the hospitals fromthe thirty sweepstakes which have now been heldapproaches .814,000,000. The highest figure for anyone sweep was reached by the one on the Derby in 1932,when .8779,899 resulted. In recent years the averagehas been between .6450,000 and ;E500,000 from eachsweepstake.

Public Health

Feeding as a Function of EducationCircular 1520 of the Board of Education is important

in itself, but more so for what lies behind it. Its avowedpurpose is to stimulate local education authorities tomake full use of the powers they possess to help thenutrition of children attending state-aided schools bysupplying meals and milk, either free or at a low cost,to those who are poorly fed, and by arranging forchildren whose parents can afford to feed them well tohave satisfactory meals at school in comfort andconviviality.The former circulars of the board on the feeding of

school-children carried the impression that what thelocal education committees were allowed to do in con-nexion with feeding was a charity granted reluctantlyto get over a difficulty which was not strictly educational,and most local authorities did as little as they couldunder this impression. In view of the history of publicassistance in England this attitude was understandableand was indeed but a survival of the school-board andboard-school frame of mind which has hampered publiceducation from its early days and from which the Boardof Education has never quite freed itself. The boardindeed suffers from its title, for the British people dislikeboards. When we have a Ministry of Education thecentral department will perhaps command greaterrespect. Circular 1520, though somewhat verbose andperhaps too insistent on the present emergency, has adifferent character. The paragraph on meals for childrencoming from a distance, though not mandatory, certainlyinsists that this provision is a necessary factor in educa-tion, and a school to which many children have to comefrom a distance cannot be considered efficient unless itis made. The milk-in-schools scheme came in as a trademeasure to help the milk business, it was advertised asa public-health measure, and in the present circular weget the first indication that it might be an educationalmeasure and that the board could foster it, not as a sideline thrust on it, but as one of its legitimate functions.The circular throughout pleads for the expansion of

communal feeding. The arguments used mainly relateto the present emergency, and for the time being arestrong enough to carry the point. But communalfeeding can be urged from the purely educational stand-point, for it teaches children to live together and developstheir manners. Its nutritional value is of course great,for it enables better, more palatable and more varieddietary to be obtained at a lower price than is possible inprivate home feeding; but it can, or should, teach thrift-the avoidance of food waste-which is one of thefavourite vices of the English, and prevents the develop-ment of faddiness about food which is one of the worstdiseases of children. Though the circular starts withfree meals for necessitous undernourished children itdevelops into something quite different, for after thefirst paragraph the adjectives " necessitous " and "under-nourished " disappear and no difference is made between" free " and " on payment " so far as the children areconcerned. The supply of free meals to necessitouschildren could never be other than a relief measure, butthe supply of meals to all children, for which the parentsin a position to do so are asked to contribute to the schoolmess, is a different matter with high educational value.

Points from School ReportsWe hear much of dirty heads and uncleanliness, but

the expressions used are vague and we are seldom givenenough detailed information to judge whether what ismeant is increasing or diminishing. We therefore com-

mend a table in the report of Dr. V. T. Thierens on theuncleanliness of the children of Blachburzz. Of 2869children. 269 had nits in their hair, but none had livinglice ; only one head-that of a boy-is reported as dirty.Twelve children, eight of whom were boys, had dirtybodies and only eight, four of each sex. were flea-bitten.None had body lice. What is meant by " clean " canbe gauged by the complete freedom from living verminand the remarkable rarity of flea-bites. The childrenwere those routine inspected, so they were cleaned up forthe purpose. In some quarters this cleansing for thedoctor’s visit is treated as though it were cheating,whereas it is a great tribute to the popular appreciationof inspection and one of the most satisfactory of itsresults. No amount of soap will efface flea-bites, so therate of flea-bitten children is a measure of permanentcleanliness, not only of persons but of households. Thisrate is seldom recorded. Fleas caught on the clothingand bodies of children are more often cat or dog flea(Ctenocephalus) than the human flea (Pulex irritans)though information on this point is meagre. In Black-burn the percentages of parents who attend medicalinspection are, for infants 80, for intermediate 60, forleaver girls 22 and for leaver boys 12. In 1939 thepercentage of children who left school with healthymouths was 82-09, the highest yet registered, andincludes all the leavers except those for whom treatmentwas refused.

Dr. W. F. W. Betenson reports that in Brecozzshirethere were 6885 children on the elementarv-school roll ofwhom 3716 were routine inspected in 1939. He gives acomplete tabulation of all crippling defects in childrenaged 5-16 years in this small rural county. There are442 names on the register, roughly 1 child in 20. Ofthese 186 suffer from flat-feet, 89 from postural defects,34 from scoliosis and 40 from deformed feet. Thesedefects account for nine-elevenths of all orthopaediccases and cannot be called crippling in the social meaningof that word, for all but 2 of the children are fit for normaleducation. Of the seriously crippled children 10 are

suitable for education in special day schools and 10require education in residential schools. There were 24cases of rickety deformities, all slight; of infantile paralysis, 4 slight cases, 5 moderate, and 3 severe; theseshow the extent of the two commonest causes of crippling.the first disappearing rapidly, the second increasing innumbers but not in severity.

INFECTIOUS DISEASE IN ENGLAND AND WALES

DURI1TG THE WEEK ENDED AUG. 3, 1940

Vo/K’aMws.—The following cases of infectious diseasewere notified during the week : smallpox, 0 ; scarletfever, 1502 ; whooping-cough, 818 ; diphtheria, 814 ;enteric fever, 119 (20 at Exeter) ; measles (excludingrubella), 9312 ; pneumonia (primary or influenzal), 425 ;puerperal pyrexia, 146 ; cerebrospinal fever, 142 ; .poliomyelitis, 25 ; polio-encephalitis, 8 ; encephalitislethargica, 3 ; dysentery, 42 ; ophthalmia neonatorum,85. No case of cholera, plague, or typhus fever wasnotified during the week.The number of civilian and service sick in the Infectious Hospitals

of the London County Councils on Aug. 2 was 661, made up of :scarlet fever, 130 ; diphtheria, 130 ; measles, 22 ; whooping-cough,20 ; enteritis, 61 ; chicken-pox, 40 ; erysipelas, 25 ; mumps, 16 ;poliomyelitis, 1 ; dysentery, 1 ; cerebrospinal fever, 28 ; puerperalsepsis, 22 ; enteric fevers, 47 ; german measles, 3 ; other diseases(non-infectious), 36 ; not yet diagnosed, 79.Deaths.-In 126 great towns, including London, there

was no death from smallpox, 1 (0) from enteric fever,3 (0) from scarlet fever, 2 (0) from whooping-cough,6 (0) from measles, 13 (0) from diphtheria, 29 (7) fromdiarrhoea and enteritis under 2 years, and 11 (0) fron-iinfluenza. The figures in parentheses are those forLondon itself.The fatal case of enteric fever was reported from Leyton (Greater

London also reported two deaths). Liverpool and Birkenhead eachhad 4 deaths from diarrhoea. There were 3 deaths from diphtheriaat Liverpool.The number of stillbirths notified during the week was248 (corresponding to a rate of 43 per thousand totalbirths), including 32 in London.

Colonel P. S. Tomlinson, late R.A.M.C., has been grantedthe acting rank of major-general and appointed director ofmedical services in a command overseas.

242 IK ENGLAND NOW

In England NowA Ruzzning Oommentary by Peripatetic CC1"TespondentsTHE first daylight air-raid warning since September

caught me driving home. I did not hear it, but sawpeople running in all directions, not at all dismayed, norushing across the road to the danger of the motorist, butjust trotting quietly home. Then the traffic began to gofunny ; buses slowed down and tacked themselves onebehind the other at the side of the road, like the whitecells in Cohnheim’s experiment on inflammation. Iwent on, wondering whether I should be stopped orwhether I was allowed 5 minutes to get home as pedes-trians are. Up the hill the traffic got scarcer, but peoplewere walking or standing about as usual, and I suspectedthe warning had not reached them. I got home to findthe missis chatting in the street with one neighbour,while another was asking her into her house thinkingshe should not be out. She had seen some firing in thesky before the warning went, and was telling someone allabout it. Very wrong but very natural. I put the caraway and went indoors just as the all-clear went. I wasglad to hear it, for I wanted my dinner. A few minuteslater I heard a noise in the street and looking out sawsome boys with sheaves of papers under their arms.They were calling to one another about leaflets. Irushed down to try and get one, but recognised from theboys’ behaviour that I had been had. I called theyoungest and he came up smiling, saying " I have onlybeen pulling your leg. Sir ! "

Next day when the siren went I was in the radiographicdepartment giving a demonstration on some films. Aswe were well underground we went on with it but thenwere faced with the difficulty of lunch. I got a cup oftea and some biscuits from the O.P. canteen and had justsettled myself with pen and paper when the all-clear went.My colleagues rather envied my having had plenty tooccupy my time. If there are to be many of these periodsof inactivity we shall have to organise something to keepthe expectant workers amused. I suggest the old game ofspillikins. The girl in the Lyons shop where I had myt-lunch told me they had had a concert in their shelter.Many will improvise such, but some preliminary planningwould be advisable.

In the evening I was just getting out of the bus whenthe warning went again. I had to go to an outlyinghospital in my car and wondered if I might do so. Iasked an air-raid warden who informed me I could at myown risk. Opening the garage I heard some firing thatsounded near but it soon passed so off I went, picking upsome petrol without difficulty by explaining my errandto the owner of the garage and showing him one of thenumerous cards that I have had foisted on me by varioussuperintendents. The emptiness of the streets aidedmotoring, but at the first cross-roads I was surprisedat finding a dozen or more vehicles held up at the trafficlights. The reason turned out to be a number ofimprovised ambulances driven furiously. I thoughtthey must have casualties, but actually they were empty-it was the exuberance of their drivers with a job inview after their long wait. Their speed was understand-able but not very wise. The greater the hurry the moreslowly should the ambulance driver go. He should sayto himself " this case is so important I dare not risk evenfive seconds delay from a meeting with another car."There were still a fair number of pedestrians about whowould have been casualties if a plane had suddenlyswooped. I do not suppose that all the English race willever obey the rules ; nor do I think this is a bad sign-a few casualties to whom it may be said " you’ve no-onebut yourself to blame " is better than a nation coweringunder cover. At the hospital the children were in highjinks on mattresses at cover-points in passages, delightedthat bed-time was deferred. The theatre-sister thankedme for giving her something to do instead of hangingabout ; as though I had produced the emergency onpurpose for her. We were about to start when there wascheering from a bunch of nurses along the passage. Irushed along thinking to see a plane brought down, butit was the all-clear sounding. The tone of their cheershowed their mental relief and yet I cannot see that thereis any strain on the Londoner. To write like this sounds

cruel to those who have been nearer it. At a hospital towhich I went on Saturday one nurse had heard she hadlost a sister killed and a clerk had lost a brother. We maywrite and behave with coolness in these raids, but wemust never laugh at them.

* * *

If the Londoner is but little disturbed, the countrymanis still less. On Sunday we heard aeroplanes so high upwe could not see them and wondered if they wereinvaders. Then the signal went and I rushed down tothe pub to get the dinner beer, fearing it would close.The bar was full. There were the usual habitués ofSunday at one o’clock, supplemented by a sprinkling ofsoldiers and a large body of bare-kneed cyclists of bothsexes. The pub did not close, but it emptied, for every-one ran into the road to strain his eyes at the skies andtry to see something more than bursts of smoke. Therewere some that interpreted every puff from the archies’shells as a plane brought down. I went back to thecottage with my beer, and was almost thought un-patriotic for insisting on putting it in a cool place beforejoining the garden group to watch the explosions.

* * *

The sea and the soil are two great healers of the mind.For the sedentary brain-worker who is mentally faggedthe best kind of cerebral holiday is one with a fairmodicum of bodily exercise. In our youth it took theshape of two rounds of golf a day, the standard of playdeteriorating steadily as the weeks went by until weswore we would never handle a club again. In middleage we seek less strenuous exercise, and what could bebetter for mind and body than fishing from a sailing-boat, or from a rowing-boat rowed by a boatman ?It was thus that I spent the greater part of my vacation,cut this year from four weeks to two, at a well-knownand secluded fishing village in North Devon. It was aform of escapism well justified by results. The warseemed far removed as the days went lazily by in idlegossip with the friendly fisher folk, garrulous andinnocently boastful, superstitious and religious, likefishermen the world over ; yet ready at a moment’snotice to man the life-boat. The warm brogue of thenatives seemed in some danger of being eclipsed by thecockney voices of 150 evacuated children. It was adelight to watch these happy youngsters from Londonsavouring the joys which the country boy takes forgranted. Only a few of the older ones wished to goback to Peckham-they were missing the movies.Incidentally, the Devonian brogue, particularly as spokenby the older generation, reminded me strongly of theAmerican--or if there is a difference the Canadian-accent, and I wondered if the Pilgrim Fathers were allwest-countrymen. We returned home to find thegarden, even after so short an absence, sorely needingattention, and a judicious mixture of weeding anddigging completed my mental rest cure. There are fewthings so soothing to a jaded mind as the smell of freshlyturned soil.

* * *

Hampstead Heath on this first war-time first Mondayof August-one daren’t call it August Bank Holiday-may not have been what it used to be, but it was a fairlygood imitation. The crowd of holidaymakers seemedas dense and as happy and was perspiring as freely asever, and the adult male was by no means an avis rara.What one missed most was the noise. Gone was theblare of music (sic) as the horses and motor-cars wentround and round, and other musical noises were mutedto conform to the new regulations ; even the barkerswere doing their barking in dumb-show. All lights andflares had to be shaded, and I imagine the evening lostmost of its glamour from the " lights out " order at8 P.M. One side-show is still as slick as ever-the clearingof the snow-storm of litter from the Heath next day.

* * *

This war is making us a suspicious race. After thesign-posts were removed I went one day for a gossip witha neighbour. At the cross-roads a car stopped and thedriver asked me the way to Town A. He seemed thenice sort of boy that works at motor garages, and wasdriving three young soldiers. I leaned on the door ofhis car and settled down for the sort of chat that we stillhave in the country on such a subject at four cross-roads,