and in the age period twelve to fifteen years the school attendants suffered nearly three times more than those who were not at school."

A similar result in the instance of scarlet fever is illustrated in the Annual Report of Dr. Murphy, Medical Officer of Health of London, England, for 1893, in connection with 17,704 cases. Of these there were: 5,279 cases under five years of age; 6,727 cases under ten years of age; 3,187 cases under fifteen years of age; or but 29 per cent. of the cases were under five years of

age.

Dr. Murphy illustrated the fact in another way by showing how the prevalence of this disease declined with the summer vacation. Thus, under three years the decrease was 1 per cent.; under three to twelve years the decrease was 26 per cent.; over thirteen years the decrease was 13 per cent. Increase in succeeding month: under three years, 4 per cent.; under three to thirteen years, 65 per cent.; over thirteen years, 26 per cent.

Such is the experience of officers of health in England; but we are able to further illustrate the prevalence of infectious diseases from our own statistics.

During the first half of 1897, we had a serious prevalence of scarlet fever in Toronto. There were in all 1,138 cases and 63 deaths.

In the returns for May, and up to the 5th of the following June, there were in all 280 cases. Of these 198 attended school, or 70 per cent. of the whole were school children.

Such are the statistics of several outbreaks in which the details regarding cases have been available. We have, however, in addition to this, always available, the study of the deathreturns from year to year for the whole Province, and for particular municipalities.

The following table, from the Registrar-General's Report of 1900, supplies a number of interesting details, by which comparative results may be obtained. It gives the population of the Province by age periods from nought to nineteen years inclusive, by years for the first five-year period, and for the three succeeding quinquennia. It further gives the deaths for each of the several periods separately for scarlatina and for diphtheria.

From the columns of totals we find that for the first quinquennium, the deaths for both diseases together were 516, and for the period of five to twenty, the legal school period, they were 352, and in the five to nine period separately, 244.

It will be observed that the ratio of deaths in the first five years of life is about three times that in the second five-year period for scarlatina, and twice that for the same period in the case of diphtheria. We see in this an apparent disagreement from the foregoing statistics regarding the cases as reported in the different illustrated statistics given.

There is, however, a natural explanation for this in the fact that the percentage mortality of scarlatina in England in 14,000 cases between 1888 and 1893 under five years was 16.8 per cent., while that for the five to nine year period was 5.6 per cent.

In the same way diphtheria which, between 1895 and 1899, had 25.6 per cent. of deaths in cases of children under five years, had 14.6 per cent. of deaths for the five to nine period. Or there were 1,536, as compared with 695. What is very pleasing to notice, however, in this study of English statistics, is the relatively great decrease in recent years, not only of the total cases and total mortality, but also of the lessening percentage in school children, due doubtless to the closer inspection of school children, and the very general removal of first cases to the isolation hospitals.

To conclude this reference to the relative prevalence in the two periods through illustrative statistics, I shall take the returns of our two largest cities, Toronto and Ottawa, for 1903. Except for the first three months of the year, the following are the number of cases, as well as deaths, for the year 1903. We find that for the ten months from March to December, Toronto had 418 cases of scarlet fever and 62 deaths, and 806 cases of diphtheria, with 100 deaths. The deaths for the whole year by ages are seen in the following table:

Comparing cases with deaths as given, we find that the percentage death rate was 14.7 for scarlatina, and that for diphtheria was 11.7. I have not the figures enabling us to determine the death-rate at different periods, but we may assume that the relative rates would be much the same as in other years and places.

We find for scarlet fever that in the nought to five period the deaths were 44, while those for the school period, five to nine

teen, were exactly the same. Applying the rate in the London Report, this means that there were three times as many cases among children of school age as in those from nought to five years.

For diphtheria it would appear that the record for children of school age is more favorable. Assuming that the London rates prevailed of two to one for the two periods, we find the prevalence in the schools to have a ratio only 50 per cent. greater than that for the nought to five year period.

The following table illustrates the relative prevalence in the city of Ottawa:

From the figures here given for scarlet fever, we similarly conclude that the prevalence of cases amongst the school children was three times as great in the five to nine period as in the nought to five year period; but we find that in the matter of diphtheria there is by no means the same relation, there being twenty-two deaths in the nought to five period, and but five in the five to nine period.

The

These figures are of extreme interest since they represent the results of a year's work, where for nine months all cases of diphtheria were removed to the isolation hospital so soon as diagnosed, and the school children of the rooms, where cases had been, were inspected till the period of incubation was over. very considerable number of cases which occurred during the year (320 of scarlatina and 351 of diphtheria) removes the element of incorrect deductions which may result from a small number of cases.

The history of these Ottawa figures as a statistical study is most interesting. For years the city had an unenviable reputation in the matter of contagious diseases. In 1902, there were in all 689 cases of scarlet fever and 234 of diphtheria. In February, 1903, a new well-equipped isolation hospital was opened, and after March all cases of the diseases occurring in the city were sent to the hospital. Of the 320 of scarlet fever, 198 were treated in the new hospital during the eleven months; the balance, 102, were treated elsewhere, or after the complete removal to hospital of all cases began, there were for the nine latter months. of the year but 159 cases compared with 161 in the first three months.

Of the diphtheria cases (251 cases), 69 occurred in the first three months of the year, and 182 in the latter nine months, during which all cases were treated in the hospital. While not directly bearing on this subject, it is pleasing to remark that the

total deaths for the nine months from scarlet fever were but three, while those from diphtheria were nine, or 1.52 per cent, and 4.9 per cent. of the cases. Such a low record of deaths for so large a number of cases has, so far as I know, never hitherto been obtained. But the other important point is the effect of the removal to hospitals of first cases in lessening the prevalence of the disease. In 1902 there were 689 cases of scarlet fever in Ottawa with thirty-nine deaths, and 487 cases of diphtheria. As a matter of fact, there has resulted from the more effective methods adopted in 1903, a reduction of over 50 per cent. in the cases of scarlatina and 85 per cent. of deaths, and 41 per cent. in the cases of diphtheria and 54 per cent. of deaths.

But little more, I think, need be said on the subject, as the methods for dealing with infectious diseases in schools will be dealt with in another paper. To me, and I think to every one, it must be apparent that practically there is no limit to the economic and life-saving results which public health work, moving along the lines of experimental science, is capable of. What it is apparent is necessary is:

1. A conviction arrived at by such statistics as have been cited that disease is disseminated in such ways as I have indicated.

2. That we be convinced by the results of such methods as have been especially illustrated by the Ottawa statistics, that an enormous saving of cases of disease and deaths is possible.

3. That we possess scientific methods so certain when persistently and systematically carried out, that they will suppress outbreaks of epidemic disease almost with the same certainty as the demonstrated amount of work which a properly constructed machine will perform with the combustion of a definite weighed quantity of fuel. All that is further required is to educate the public that such work is life-saving and patriotic, and that, like all other philanthropic work, the results are not only good to the receiver, but also to the giver. As Sir Launfal, in his search for the Holy Grail, came to realize:

"The Holy Supper is kept, indeed,

In whatso we share with another's need;
Not what we give, but what we share;
For the gift without the giver is bare;

Who gives himself with his alms feeds three :
Himself, his hungering neighbor and me."

THE NECESSITY OF PHYSICAL EDUCATION IN OUR SCHOOLS AND THE UTILITY OF MILITARY

INSTRUCTORS.

BY CHAS. A. HODGETTS, M.D., L.R.C.P. (LOND.),

Secretary of the Provincial Board of Health of Ontario, Capt. A. M. S., Canada.

BEFORE Considering how a system of drill can be provided for, and by its enforcement during school and college life the general health and physique of the people improved, and incidentally the male population trained in military knowledge, it may not be out of place to briefly review the present situation, and consider some of the baneful consequences of neglect of this important class of education.

To discuss at length the importance of this branch of education is entirely uncalled-for before this gathering of educationalists and sanitarians; of its necessity as a part of the educational system most, if not all, are already convinced. We may differ in methods and the details for the carrying out of drill; but of this we are all convinced the necessities of this twentieth century as regards both the boy and the girl require a sound body as well as a sound mind. For many years the youth have been treated to an intellectual feast where their brains became satiated with saccharine and starchy educational tit-bits, or the cream puffs of some educational faddist, or ad nauseam, have had to swallow that which was mentally indigestible. All this, too, in environments both at school and in the home, which would not suit even the most lenient sanitarian. Thus have the youth been trained in the past, the chief aim of education apparently having inclined to the Scriptural injunction. "With all your getting get understanding." The result of past methods has been largely an intellectual victory; but the victory has been gained at considerable cost. We have now, however, reached that stage when we are con vinced that the race of life is not to the swift mentally, nor can the physically strong always win its battles. The conclusions drawn from the physiological investigations made in Europe and America into the distortion of the body caused by the demands and pernicious practices of school life are startling in the

extreme.

Prof. E. R. Shaw, New York University, writing in 1901, says: "Despite all that has been written of the dependence of mental development, there has not yet been accorded to physical culture the place in our schools which its importance demands.

*Read at Conference on School Hygiene and Education, February 2nd, 1904.