An Early Attempt at Contact Tracing at the Rivers School

September 8 marks the start of a new school year at Rivers. It is obvious that Rivers has
evolved in numerous ways since the school first opened in 1915. In most cases this evolution has
involved the introduction of new things and the discarding of old or outdated practices. This year
students will be reintroduced to one long-discarded practice from the past: seating charts. Because of
Covid-19, and the potential need to rapidly initiate contact tracing should a student or teacher test
positive for Covid-19, each teacher will be required to create seating charts, and students will be
required to sit in those assigned seats for the duration of the pandemic. It will likely come as no
surprise that seating charts are not new at the Rivers, but it may come as a surprise that the use of
seating charts for contact tracing is also not new. The story of seating charts and contact tracing at the
school harkens back to the school’s early days and one of the most influential doctors who advised Mr.
Rivers.

Robert Rivers was driven to found his school by a concern to keep “healthy boys healthy.” He
was convinced that good health was critical to educational success and the open air and sunshine were
keys to maintaining good health in healthy boys. Mr. Rivers had very definite ideas about health, but
during his tenure from 1915-1929 he sought advice from a panel of young doctors, each of whom
represented a different specialty and resulted in a comprehensive knowledge base from which to
draw. The head of this advisory panel was Dr. Richard Smith (1881-1981). Dr. Smith was educated at
the Mt. Herman School, Williams College, and Harvard Medical School, graduating in 1907. Pediatrics
was a relatively new specialty when Dr. Smith was a medical school student, but it was quickly gaining
prominence, and it would be the focus of Smith’s teaching, research, and practice for his entire career.
Over the course of that career he built an impressive resume of achievements in pediatrics. A short list
of those achievements include being a founder of the American Pediatric Society and later its

president; serving as Thomas M. Rotch Professor of Pediatrics at Harvard Medical School; serving as
Physician-in-Chief of Children’s Hospital from 1942-1946; serving as the first head of the department of
maternal and child health in the Harvard School of Public Health; and teaching the first course (at the
HSPH) in the United States on the “maintenance of health in the well child.” His two books Baby’s First
Two Years and From Infancy to Childhood were standards for pediatricians before being supplanted by
the works of Dr. Spock.

During his time at Rivers, Dr. Smith wrote many studies and authored numerous articles on how
to raise healthy children. His experiences at Rivers, particularly his observations of boys at the school,
provided important evidence for his research. One particular article “Respiratory Infections in
Children” is especially relevant to the current situation. Smith read it at the Annual Meeting of the
American Pediatric Society, held at Swampscott, Massachusetts on June 2, 1921. The paper was later
published in the Transactions of the American Pediatric Society that same year. His goal for the paper
was to study the transmission of respiratory infections in a school and contribute to the debate on,
what was, the most dangerous family of diseases affecting children in the early twentieth century.

Smith was ultimately disappointed in the outcome of his study. While it achieved some useful
results, the study did not achieve the breakthrough in understanding that he had hoped for. “This
study was undertaken in the hope that some suggestions might result as to a more definite means of
combatting them [respiratory infections]. It has been unsatisfactory in many respects from that point
of view. It has demonstrated clearly several things, the most striking of which is our lack of real
knowledge with reference to these infections and the necessity for further study.” Despite his
disappointing in the result, Smith was able to confirm the significant role played by respiratory
infections in student absences: “An analysis of absences due to illness shows that the most important
diseases responsible for absences are respiratory infections.”

In the paper, Smith presents three tables showing data for student absences that he collected
for the 1917-1918, 1918-1919, and 1919-1920 school years at Rivers. The article also contains seven
figures that chart his attempts to use “contact tracing” to follow the spread of respiratory illness
through the student population during academic periods, lunch, and during rest periods. Many of
Smith’s papers are archived in the Countway Library at Harvard Medical School. Among them are his
notes for this paper, which contain student seating charts and his penciled-in notes about students,
their illnesses, and possible transmission paths. This attempt at “contact tracing” to illuminate
respiratory illness, did allow for some interesting observations: “Definite contact infection cannot be
proved. It is striking, however, that the distribution of respiratory infections at any one time is in
general among boys who are near together, particularly those who are near together at rest period or
in music. This would indicate the desirability of particular precaution during these times, i.e. during
times of close contact or when using the voice.”

Smith used contact tracing in his paper in a proactive effort to shed light on how to combat the
spread of respiratory diseases. In contrast, the contact tracing going on today is focused more on
identifying those at risk of infection by Covid-19 due to contacts with positive cases, a process that
happens after the fact. Smith’s paper did not break new ground, is not the subject of discussion in
medical circles today, and did not give rise to other studies of the transmission of respiratory illnesses,
but it does provide an interesting, early example of a study using contact tracing.
Back