BAR 69 Barking Town Urban District Council THE ANNUAL REPORT OF THE School Medical Officer For the Year 1927. C. LEONARD WILLIAMS, B. Sc., M.R.C.S. L.R.C.P., D.P.H. 2 SCHOOL MEDICAL STAFF, 1927. School Medical Officer : C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P,, D.P.H. Deputy School Medical Officer : MURIEL J. LOUGH, B.Sc., M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Orthopaedic Surgeon : r B. WHITCHURCH HOWELL, M.B., B.S., F.R.C.S. Radiologist : ANGUS E. KENNEDY, M.R.C.S., L.R.C.P., L.S.A. Dental Surgeon : H. S. SMYTH, L.D.S., R.C.S. (Eng.). Masseuse : Miss A. E. FINDLAY, C.S.M.M.G. School Nurses : Miss L. F. SWAIN. Miss F. YOUNG (Dental Nurse). . Miss S. E. W. GIBSON. * Clerical Staff : E. W. WINCHESTER (Chief Clerk). Miss A. SHAW (Resigned 10-12-27). Miss V. SHEAD. Miss B. INGHAM (Resigned 23-7-27). Miss H. NUNN. * ⅓ of Salaries charged to School Medical Service. 3 Barking Town Urban District Council. PUBLIC HEALTH OFFICES, BARKING, ESSEX, April, 1928. To the Chairman and Members of the Local Education Authority. Mr. Chairman, Ladies and Gentlemen, Late in September, 1927, I took up the office of Medical Officer, to which I had had the honour of having been appointed by you earlier in the year. It is possible, therefore, for me only to speak personally of your Service for the last quarter of the year under review, but I have . drawn up the Report for your convenience for the whole year. In drawing up the Report I have, in these circumstances, been constrained to follow very closely the lines of the last Annual Report. I wish to acknowledge the very considerable help I have received from this Report, and the further help I have received from my staff, without whom it would have been impossible for me to have presented the Annual Report I now beg to submit for your favourable consideration. Yours very faithfully, C. LEONARD WILLIAMS. 4 ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER For the Year 1927. (I) STAFF. The year 1927 has seen changes in the staff of the Public Health and School Medical Services. Dr. Kerr Simpson resigned in July-, 1927, and your present School Medical Officer took up his duties towards the end of September. Mr. W. Y. F. Dawe, Dental Surgeon, resigned on 30th September, 1927, and Mr. H. S. Smyth was appointed to fill the vacancy caused by this resignation, taking up his duties on the 17th October. Of the clerical staff, Miss A. Shaw resigned 011 the 10th December and Miss B. Ingham 011 the 23rd July. The vacancy caused by the resignation of Miss Ingham was filled by the appointment of Miss H. Nunn on the 2nd August, and the vacancy caused by the resignation of Miss Shaw was tilled by advancing Miss Shead to the vacancy, and the clerical staff brought up to its present strength by the appointment of Miss H. King early in 1928. The present amount of clerical work has been found a great strain on the staff, and takes more than the ordinary working hours of the present clerical staff. (2) CO-ORDINATION. (a) Infant and Child Welfare.—The Council as the Local Sanitary Authority and the Council as the Local Education Authority have co-ordinated their public health services in so far * 5 as the medical officers and the dental surgeon to the one Authority carry out similar duties for the other Authority also, but it is passing strange that, 10 years after the creation of the Ministry of Health, there is still, both centrally and locally, a diversity of services operating in the field of Public Health. The circumstance that your medical officer is also District Tuberculosis Officer for the Essex County links up the whole of your work with the Tuberculosis Service for the area administered by the Local Authority. (b) Nursery Schools.—There are no nursery schools in Barking. I do not advocate the provision of such schools, and, although I am conversant with the evidence which has been adduced in favour of establishing these schools, and the high authority of those who have written in support of them, I still believe no reasonable case has been made out, unless we are prepared to say that our educational system has entirely failed, which I am not prepared to say. May I put it this way The family is still the unit in our national life, and we have only reasons for interfering with it in order to supply children with facilities they cannot obtain in their own homes. There are, it is agreed, many homes where the environment is prejudicial to the development of young children. In so far as this is due to material circumstances, such as bad housing, it is obvious that the right course to pursue is to improve housing rather than to provide nursery schools, and in so far as this is due to bad mothering, the obvious remedy is to educate our children in those principles which are the principles of wise motherhood. I do not mean that our educators should undertake lessons on sex hygiene etc., but that these girls should be so thoroughly grounded in the elements of hygiene, and their intellect and wit so sharpened, that when, in the fullness of time, they develop into the mothers of the nation, the health visitors will find them anxious and competent to profit by the instruction which is in their power to give. Either our educational system is more and more providing this type of mother, or it is not. So far as girls are concerned, this is the crucial test of its efficiency. I am persuaded it is efficient, and is becoming more efficient, that the day of maternal ignorance 6 and apathy is passing, and that it would be unwise for any authority to commit itself to heavy expenditure for a passing social disability. There is, of course, one other consideration, and that is the fact that nursery schools can be so run that they take the place of creches, and so release a large number of women for industrial life. This, however, is an industrial, and neither a Public Health nor an educational question. (c) Care of Debilitated Children under School Age. Orthopaedic treatment, dental treatment and the treatment of minor ailments is provided for the children under school age by the Public Health Committee, and the Education Committee provide such treatment for all children up to the age of school leaving. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. (3) SCHOOL HYGIENE. A new infants' school (St. Joseph's), has been opened during the year, which has to some extent relieved the overcrowding at St. Ethelburga's. The fact that no facilities exist, except at the Special and Park Modern Schools, for the drying of children's clothes and boots was brought before your notice in the last Annual Report. This is an urgent matter, and should have your serious consideration forthwith. It is difficult to understand how schools ever came to be built without such elementary provisions being provided for maintaining the health of the children, and it is difficult now to repair the disastrous apathy of a past generation to the fundamental principles of healthy childhood, but the problem is not insoluble if sufficient money is available, and I am happy in believing you fully realise the necessity of making quite sure that whatever education your children receive at school shall not be paid for by them in ill-health. 7 School. No. of children who do not return home for mid-day meal. Whether facilities exist for heating of children's meals. Whether facilities exist for the drying of children's clothes and boots. Park Modern— 30 Yes Yes C. of E. Boys — No School fires in winter only. Girls — „ „ Infants — „ „ Ripple— Boys „ „ Girls — „ „ Infants — „ „ Catholic Mixed 18-20 „ „ Infants 25 „ „ (St. Josephs) Gascoigne Boys 8 „ „ Girls 2 Gas ring „ Infants — No „ Westbury Boys 4 „ „ Girls — „ „ Infants — „ „ North Street— Boys 5 „ „ Girls 2 „ „ Infants 2 „ „ Creeksmouth— — „ „ Castle— 40-50 Small stove in teachers' private room. „ Faircross— All children stay at school for mid-day meal, the food being supplied from Municipal Kitchen Yes Yes PROVISION OF MEALS. (i) Meals are provided at Faircross School. They are also provided at the Municipal Restaurant. (ii) In all of the ordinary elementary schools most of the children return home to the mid-day meal. Sometimes the children staying to lunch buy dishes cooked during domestic science lessons, and, in some circumstances, supplies of hot cocoa and hot milk are available. 8 (4) MEDICAL INSPECTION. The age groups recommended by the Board of Education are examined annually. Head Teachers kindly send notice to parents of forthcoming examinations, and the kindly support of Head Teachers materially helps in getting parents to attend on the occasion of the examination of their children. The following table shows the number of children examined by routine and otherwise, and the percentage of defective children found at the examinations. Entrants. Intermediates Leavers. Specials. Other Routine Examinations. Total. No. of children examined 918 483 566 89 193 2,249 No. referred for treatment 149 69 85 66 8 377 No. referred for observation 209 101 76 15 6 407 Percentage of defective children 38.9 35.1 28.4 91.01 7.2 34.8 In 1927 the parents of 62.7 per cent. of the children were present at examination, the comparable figures for the two previous years being, in 1926 60.7 per cent., and in 1925 65.5 per cent. The number of children on the school register on 31st December, 1927, was 7,001, compared with 6,855 on 31st December, 1926. During the year, the Medical Officer paid 121 visits to 23 departments for inspection purposes, examinations being conducted throughout the year on the various school premises. Certain cases of defect were, as in previous years, referred to the School Clinic for further examination and treatment. . 9 The following table shows the number of children examined at routine and special inspections during 1927, classified according to the schools attended, the number of inspections held in each school and the number of parents or guardians present:— COUNCIL SCHOOLS. School. No. of inspections. Numbers inspected. No. of parents present. Boys. Girls. Park Modern 4 45 52 40 Gascoigne 24 234 239 343 North St. 21 184 169 240 Castle 2 30 12 15 Creeksmouth 1 4 2 4 Westbury 21 198 195 288 Ripple 16 153 187 245 Faircross 10 103 90 47 VOLUNTARY SCHOOLS. Church of England 15 115 126 135 Roman Catholic 7 50 61 54 (5) FINDINGS OF MEDICAL INSPECTIONS. Table II., Appendix (a), gives a return of defects found during the course of routine examination. Of those examined at routine and special inspections, 784 or 34.8 per cent., had some defect and the actual percentage requiring treatment was 16.7. (a) Uncleanliness.—I am advised that the satisfactory decline in uncleanliness noted last year has continued. 10 It cannot be too often emphasised that cleanliness is the basis of good health. Without in the least slighting the enormous advances which have been made in curative and preventative medicine, it must be recognised by the public generally that the greatest things which can diminish the present burden of ill-health, and the 'greatest things which can promote health itself are not those which can be done for the people, but those which can be done by the people, and, amongst these, the elementary principles of cleanliness represent perhaps the greatest factor we have in our control. "Where there is dirt, there is danger," and dirt and disease go hand in hand. A cleaner people will be a healthier and a happier people, and the decline in uncleanliness, i.e., the promotion of cleanliness, of which I am advised is a sign of the happiest moment. Surveys under the above heading were carried out at (i) routine medical inspections, and (ii) special inspections conducted by the school nurses. (i) At the former, 227 children out of a total of 2,249, or 10.09 per cent., had nits in their hair, while 1, or 0.04 per cent., had head or body vermin. (ii) During the year the school nurses made 18,367 individual investigations, compared with 17,952 in 1926, of which number 1955 children were found to have nits only, 121 harboured nits and head vermin, whilst 5 had verminous bodies and clothing. 251 home visits in connection with uncleanliness were made during the year. As formerly, cases were seen at the School Clinic after exclusion by nurses or teachers, of which number 67 had nits and 45 head or body vermin. For purposes of these inspections the various schools are divided between two school nurses, every school is fully inspected during each term, and the results of these examinations are as follows :— 11 School. Dept. No. of Examinations Nits only. Nits and Vermin (head) Body and clothing verminous. Gascoigne Infants 1408 156 13 2 Boys 1431 42 ] 2 Girls 1245 248 9 — North St. Infants 1635 120 3 — Boys 948 39 2 — Girls 1033 159 5 — Castle Infants Boys Girls 361 48 9 — Creeksmouth Infants Boys Girls 81 11 2 — Westbury Infants 1188 123 14 — Boys 1060 34 3 — Girls 1154 176 5 * Ripple Infants 862 68 3 — Boys 1054 23 1 — Girls 906 107 — — C. of E. Infants 614 117 9 — Boys 611 52 6 — Girls 582 189 11 — R C. Infants 274 42 4 — Boys Girls 708 122 11 1 Faircross 644 64 10 — Park Modern Mixed 565 15 — — Printed instructions are in all cases sent to parents or guardians of children excluded from school as result of verminous conditions, cleansing of the verminous person and clothing when necessary being subsequently undertaken at the School Cleansing Station. During 1927, 183 cases were dealt with. In submitting to you the foregoing table, which has reference to the number of infested children found at the various schools, I wish to make it perfectly clear I am following precedent, and I wish further to make it quite clear that the figures cannot be used strictly for comparing school with school as to efficiency. Different schools have different problems to face, which makes comparison impossible, and I have no doubt you are convinced 12 that your Head Teachers and teachers are, one and all, dealing with their particular problems whole-heartedly and efficiently. Clothing.—Children with dirty clothing numbered 8 or 0.3 per cent., compared with 14 or 0.5 per cent. in 1926. Children with defective footgear numbered 14 or 0.6 per cent. Cases of children with defective footgear were as heretofore referred to the Boots Minor Sub-Committee, who considered applications for the provision of boots in 172 cases, compared with 198 in 1926. In all 172 children were supplied with boots during the year. (b) Heights and Weights.—The following table gives the average heights and weights of children examined at the three undermentioned age periods in four of the schools, compared with the results at similar age periods in 1924, 1925 and 1926. Year. Average Height in Inches. Average Weight in Pounds. 5 vrs. 8 yrs. 12 yrs. 5 yrs. 8 yrs. 12 yrs. 1924 41.5 48.1 58.7 39.3 52.4 82.4 1925 42.1 49.05 56.5 41.1 54.1 78.8 1926 42.4 49.9 57.5 40.3 54.6 82.4 1927 42.2 49.3 57.1 40.6 52.5 80.1 Average for 4 years 42.05 49.08 57.4 49.3 53.4 80.1 (c) Minor Ailments.—Minor ailments are seen daily at 9 a.m., excepting Sundays, at the Clinic premises in East Street, the staffing of this Clinic being provided by nurses of the Plaistow Maternity Charity. For particulars of cases treated, see Table IV, Group I. Instances of uncleanliness found amongst children seen at this Clinic were those excluded by teachers, school nurses, or attendance officers prior to being re-admitted to school. (d) Skin Disease.—The common skin diseases met with are Impetigo, Septic Sores, Seborrhoea, Scabies and Ringworm. Table II gives the numbers found among the routine and special 13 examinations. They amount to 0.9 per cent. among routine cases. One case of Ringworm of the scalp and 2 cases of Ringworm of the body were met with during the year. (e) Eye Diseases.—These diseases chiefly comprising Blepharitis, Conjunctivitis and styes, either indicate faulty personal hygiene or some error in refraction. They form a very important section of the minor ailments found in school children. Table II gives the findings under the respective heads. They amount to 13 among routine and special cases. (f) Vision and Squint.—105 cases of defective vision were found and 9 cases of Squint, 92 and 8 cases respectively being referred for treatment. This gives 4.4 per cent. requiring treatment. (g) Ear Disease.—Defective hearing is measured by means of the whisper test at 20 feet. 3 children, or 0.1 per cent., were found to be deaf, while 21 or 0.9 per cent., suffered from ear disease, the latter generally having discharging ears and a certain amount of deafness in consequence. Defective hearing is either due to wax or middle ear disease which is much more untractable, a third and very common cause of defective hearing being adenoids, the removal of which usually cures the deafness. The prevalence of ear disease among entrants amounted to 1.1 per cent. (h) Tonsils and Adenoids.—443 children, or 19.6 per cent. of those examined, were found suffering from enlarged tonsils or adenoids, or both, with such symptoms that it was found necessary to refer them for treatment or further observation. Of cases referred for treatment, 181 were found on re-inspection to have been treated. As in former years arrangements existed for the operative treatment of post-nasal growths at the Throat Departments of St. Mary's Hospital, Plaistow, and Queen Mary's Hospital, Stratford, parents contributing to the cost thereof according to means. It will be noted that the total number of children in whom a diagnosis of enlarged tonsils and adenoids was made was 443 this year as against 357 for the previous year, i.e., 19.6 per cent. of those examined as against 12.9 per cent. for the previous year. 14 It appears from investigations that these figures do not actually prove the increase in the incidence of enlarged tonsils and adenoids that they suggest. The probable explanation is that during the year there was rather a different standard set up for such cases requiring observation, and it will be noted that the actual number of cases treated was practically the same as in the preceding year. In the Annual Report for last year it was stated that adequate facilities at either of these Hospitals do not exist for the overnight detention of all children after operation. This is a matter for your further consideration, as all children should be retained in hospital after the surgical treatment of tonsils and adenoids. This ideal is practicable at a cost which, in my opinion, would involve the Town in a liability of from three to four times the amount of money spent at present on this service. Home visits by the school nurses to children operated upon are paid on the patient's return home, while in certain cases children are brought home by ambulance after operation. Last year's Report also drew your attention to the fact it would be a decided advantage if the arrangements of bringing children home from the hospital by ambulance, which is now only adopted in selected cases, were made general. This question is having your present consideration. The percentage of the above affection found among entrants was 22.2. (i) Tuberculosis.—The total number of cases of tuberculosis in school children notified to the Medical Officer of Health during the year was 22. During the year 57 cases were referred to the Tuberculosis Officer, of whom 13 were subsequently notified as tuberculosis. The total number of attendances bv children of school age at the Dispensary amounted to 218, while during the year 14 children were recommended through the Essex County Council for hospital or sanatorium treatment. Quiescent cases of the disease were as in previous years admitted to the Open-air School, Faircross, and numbered 74. 15 (j) Dental Defects.—The findings at Medical Inspection mostly relate to oral sepsis, i.e., gum boils and inflamed gums due to decayed teeth. These are matters of some urgency leading to digestive and other troubles due to absorption of purulent matter. The amount of dental trouble amongst entrants amounted to 55.07 per cent. This matter is further dealt with in the dental surgeon's report on pages 34 to 36. (k) Crippling Defects.—Marked deformities of such a degree as to cripple a child are becoming less numerous, as these conditions are being dealt with under the orthopaedic scheme now in existence in the pre-school age. Such defects as come to notice are found in Table II of the Appendix and consist of various degrees of fiat foot, knock knee and spinal curvature. Cripple children are educated at the cripple class of the Special School, Faircross. (6) INFECTIOUS DISEASE. As the School Medical Officers are also the Public Health Medical Officers, the occurrence of infectious disease is known to them at once and steps taken accordingly. Code : Articles 45 (b), 53 (b) and 57.—No schools were closed during 1927 for infectious disease, but the School Medical Officer submitted in respect of two schools a certificate under the Board of Education Amending Regulations, No. 2 (a), 1924, for purposes of apportioning grant. (a) Scarlet Fever.—117 children were reported in 1927, compared with 78 in 1926, the contacts excluded numbering 183. (b) Diphtheria.—39 cases were reported in 1927 compared with 35 in 1926, contacts excluded, numbering 97. (c) Measles and German Measles.—Only 1 child was reported from schools during the year, compared with 353 in 1926. (d) Chicken-pox and Whooping Cough.—99 children were reported during the year. 137 home visits were paid by the school nurses in connection with infectious disease during the year, whilst 312 visits were paid by the sanitary inspectors in connection with notifiable cases. 16 (7) FOLLOWING UP. Arrangements for following up cases of defect are as follows : Children referred for treatment from routine inspection are visited and advice offered the parents by the school nurses as how best whatever treatment may be necessary can be obtained. Following-up cards are kept in respect of all children referred for treatment from routine or special examination, and on subsequent visits of the medical officer to the school such children are reinspected to see whether treatment has been carried out and its results. Children for whom glasses have been prescribed are re-inspected within three months of the original examinations. Children whose tonsils and adenoids have been operated upon are re-inspected at the Clinic, the necessity for further attendance at hospital being thus minimised. Cases where treatment is not obtained elsewhere and which fall within the category of Minor Ailments are dealt with at the School Clinic. Of the number of children referred for treatment during the year, 56.3 were found to have been treated, compared with 59.45 in 1926. . A summary of the work of the two school nurses during the year is as follows:— No. of visits to schools 219 No. of visits to schools for medical inspection 121 No. of Home visits in connection with:— (a) Routine Medical Inspections 3419 (b) Infectious Disease 137 (c) Uncleanliness inspections 251 (d) Non-attendance for treatment, etc. 367 No. of children cleansed at cleansing stations 17 (8) MEDICAL AND SURGICAL TREATMENT. The presence of defects having been ascertained, provision is made for treatment as follows:— Parents are notified as to what has been found, and requested to make arrangements for medical attention either locally, if possible, or with neighbouring hospitals or institutions. There are numerous conditions, minor ailments especially, which would escape attention altogether unless the authority arranged for their official attention. The number of cases referred for treatment will be found in the sub-divisions of Table II, while the numbers treated, and whether by the authority's scheme or not are set forth in Table IV. " The methods adopted to secure treatment are the consistent following up of cases ; the provision of clinics (set forth as under), and other items referred to in this Report such as transference to the Open air School, etc. The value of a perfect set of teeth is even yet not fully realised, and there are still too many people who do not avail themselves of the services now placed at their disposal. The terrors of the dental chair of twenty and thirty years ago still remain, although, as an actual matter of fact, dentistry has been reduced to an almost painless operation. If reference is made to the table of heights and weights shown in the findings of medical inspections, it will be seen that, between the age of five years and twelve years, your average child more than doubles his or her weight. Feeding is therefore a most important consideration in the healthy development of the child, and this is practicable only where children have a good set of teeth. I would further point out that, to achieve a perfect set of teeth, it is not only necessary to look after the permanent teeth 18 when they come, but to look after the temporary teeth, i.e., the milk teeth, because you cannot expect healthy teeth to grow in gums which are diseased owing to the presence of unhealthy temporary teeth. • In 1927 the various clinics established included :— 1. Minor Ailments Clinic, East Street.—Mornings on days at 8.30 o'clock. , 2. Opthalmic Clinic, Central Clinic, East Street.—Half-day, Saturday mornings. 3. Throat and Nose.—Operations for tonsils and adenoids are carried out by arrangement with neighbouring institutions, no facilities for the purpose being available locally. 4. Examination Clinic, East Street.—For the further tion of special cases and cases referred from routine inspections which are seen at the close of the Minor Ailments Clinic. Examination of backward children and the subjects of suspected mental or physical defect are carried out by the School Medical Officer at the Public Offices, where arrangements are made to suit the convenience of parents and others. 5. Dental Clinic, East Street.—Twice daily except one session per week employed on dental inspections at school. 6. Tuberculosis.—By arrangements with the Essex County Council, the Medical Officer of Health is Tuberculosis Officer for the district. Suspected cases of tuberculosis are referred from routine inspections or from any of the Special clinics to the Tuberculosis Dispensary at 37, Linton Road. The Tuberculosis Dispensary is run in close touch with the open-air classes of the Special School, arrangements being made through the Essex Count}* Council for appropriate cases being admitted to hospital or sanitorium. 19 7. Ringworm Clinic.—Attendance by arrangement at the rooms in Plaistow of the Radiologist, Dr. A. Kennedy. 8. Orthopaedic Clinic.—Massage, electricity, radiant heat, remedial exercises, etc., are provided for cripples and others at the Orthopaedic Clinic of the Special School during six sessions per week, when the masseuse is in attendance. Artificial sunlight treatment now forms part of the treatment of rickets, surgical tuberculosis, and various other debilitating conditions. Advantage is taken of the facilities provided at this clinic by the Public Health Committee for children under school age by arrangement with the Education Committee. Monthly visits to the clinic are paid by the orthopaedic surgeon for purposes of examining new cases and those undergoing treatment. When necessary children from the Orthopaedic Clinic are admitted to Brookfield Orthopaedic Hospital, Walthamstow, and Queen's Hospital, Hackney, for operation or other special surgical treatment, facilities also existing for X-ray examination at the latter institution. Payment for Clinic Treatment.—Bv instruction of the Board of Education, the following scale of charges has been made:— (a) Spectacles—2/9 per pair. (b) Tonsils and Adenoids operations—5/- per operation. (c) X-ray Treatment.—No charge. (d) Minor Ailments—1/- per 3 months after 14 days free treatment. (e) Dentistry—6d. per extraction, and 1/- fillings or wiring. (f) Orthopaedic Treatment—No charge. Free medical treatment will continue to be given where parents cannot afford to pay. During 1927 payments made in accordance with scale amounted to £3 16s. 9d. 20 CLINICS.—The numbers of school children attending in 1927 Were as follows:— Clinic. No. Of children seen. Total No. of attendances. Minor Ailments 1804 9629 Opthalmic 137 358 Dental 2193 2377 Ringworm 8 24 Orthopaedic FOR EXAMINATION 38 1792 FOR TREATMENT 78 Minor Ailments Clinic. No. of days clinic was open 302 Total No. of attendances 9629 Daily average attendance 31.8 No. of cases treated 1804 In the absence of local hospital facilities, this clinic continues to supply among school children an undoubted need within the district. Three nurses on the staff of the Plaistow Maternity Charity attend daily from 8.30 a.m. to 11.30 a.m. Last year reference was made to the fact that the work of these various clinics was carried on in such a way as to encroach as little as possible upon the work of private practitioners. This is a policy which will be maintained, and I myself have no hesitation in assuring you that, whilst from time to time no doubt cases will receive attention at your clinics who might perhaps have been referred to private doctors, on the other hand your medical service is responsible for advising parents to consult medical practitioners under circumstances where otherwise they would not call in expert help, and that, if a balance were struck, it would be found certain that no injustice accrued whatsoever. The faulty state of the premises and the interference of the due efficiency of the work to some extent in consequence was dealt with in my predecessor s Report for 1925. 21 — 22 PARTICULARS OF WORK DONE IN CONNECTION - WITH ORTHOPEDIC CLINIC. No. of visits by Orthopaedic Surgeon No. of visits by Masseuse ATTENDANCES Primary Examination Re-Examination For Treatment Total School Children Under School Age School Children Under School Age School Children Under School Age 10 244 38 18 127 29 1627 676 2515 TREATMENTS Massage Electricity Remedial Exercises Ultra Violet Therapy Radiant Heat Dressings and Splintage No. of Children No. of Treatments No. of Children No. of Treatments No. of Children No. of Treatments No. of Children No. of Treatments No. of Children No. of Treatments No. of Children No. of Treatments School Children 11 345 4 117, 31 1011 18 651 4 57 10 199 Under School Age 8 120 — — 4 30 73 594 — — 5 61 Admission to Orthopaedic Hospitals On waiting List for Admission 31/12/27. School Children Under School Age Total School Children 1 Under School Age Total 7 3 10 — — — 23 Skin Diseases.—Most skin diseases fall within the group of Minor Ailments, the following being under treatment during the year:— Ringworm. Scabies. Impetigo. Other Skin Diseases. Minor injuries, bruises, sores, &c. Head. Body. 9 25 23 290 135 330 Ringworm of the Scalp constitutes a most difficult problem to be dealt with, necessitating in most cases the services of a competent radiologist, the consensus of opinion now being that treatment other than by X-rays is of very doubtful utility, necessitating even if successful a protracted period of exclusion from school—six months or more. For parents who consent to X-ray treatment this is carried out by Dr. Kennedy, who, upon receiving instructions, makes appointments directly with the parents of the child, inspects the child after epilation and in due course advises me when the child is lit to resume attendance at school. As previously, the cleansing station proved a valuable adjunct in the treatment of Scabies, 20 cases being dealt with during the year. Dental Defects.—Statistics dealing with the year's work will be found under Table IV, Group IV, of the Appendix, while the Dental Surgeon's report appears separately on pages 34 to 30. Crippling Defects and Orthopaedics.—This subject has been specially dealt with by Mr. Whitchurch Howell, F.R.C.S., Orthopaedic Surgeon, whose report appears separately on pages 31 to 33. Ten monthly visits were paid by Mr. Howell during the year, while 244 sessions of 3 hours were attended by the masseuse. 11 children were treated by massage, 4 by electricity, and 31 by re-educational exercises, while 7 children were admitted to Brookfield Orthopaedic Hospital or Queen's Hospital, Hackney, for special surgical treatment. Ultra violet light forms part of the routine treatment for many conditions of children of and under school age, 18 of the former and 73 of the lattei being so treated during the year. Total attendances at this Clinic during the year numbered 2515. 24 (9) OPEN-AIR EDUCATION. (а) Playground Classes.—All schools, including the Open-air School, have playground classes during the summer months when weather is suitable. Drill is also taken in the open when weather permits. The value of these open-air classes can hardly be overestimated. They should be encouraged, and whilst, with regard to drill, I have repeated the text of the report for the previous year, I myself feel that this same idea should be stated from a different angle. I would put the matter thus—that drill must be taken in the open unless weather conditions forbid. In other words, there should always be a very satisfactory reason if drill is not taken in the open air. (b) School Journeys.—No school journeys were undertaken, although several visits were paid to places of educational interest. (c) School Camps.—No school camps were held, but four holiday camps, each of two weeks duration, were held as in previous years at Hainault for necessitous children, whilst, for the same class of children, during the period 20th May to 23rd September, twelve week-end camps were arranged at the same place. All the children were medically examined by the staff prior to going to camp. These holiday camps have earned a well deserved reputation and their extension is, I know, a question in which you are rightly interested. (d) Open air Class-rooms in Public Elementary Schools.— Apart from the class-rooms of the Special School, which belong to the type of open-air rooms, none of the elementary schools of the district possess open-air class-rooms. To some extent this difficulty, however, is provided against in the classes of the Park Modern School and St. Joseph's Infants' School. The fact that your Special School is often called an open-air school reflects adversely on those who were responsible for the building of the ordinary elementary schools, because ail schools should be built on the open-air principle such as you have 25 porated in the new schools which have been built under your direction. (e) The Authority possesses an Open-air School at Faircross, situated centrally and upon probably what is the highest ground of the district. During the year 141 children were on the register, 74 were admitted, and 16 sufficiently improved to permit of their return to ordinary elementary school. The school combines separate departments for delicate children and mentally and physically defectives, such cases being found from routine and special inspections at school, besides those referred from the inspection clinic and tuberculosis dispensary. The general routine of the school was described in the Report for 1924. The benefit derived here is marked, but slower than at a residential open-air school, probably on account of the intervening home environment. (/) Residential Open-air Schools.—The Authority possesses no residential open-air schools. The possibility of turning Faircross School into a modified residential school, at least during the summer months, should be entertained. The advantages of such a residential school over and above a day school are very considerable indeed, and you have at Faircross a well-equipped institution which, for the greater part of the week is lying idle. It might be possible, at first perhaps under a voluntary system, to arrange for responsible persons to be in charge of at least small numbers of boys and girls who would remain at the school day and night. I feel sure that an appeal made by the Local Authority would meet with a satisfactory response. (10) PHYSICAL TRAINING. There is no area organiser of physical training. (11) PROVISION OF MEALS. Extra feeding in the form of milk, cocoa, cod liver oil, etc., is supplied to children attending the open-air classes of the Special School throughout the year, while all children at this school receive a hot mid-day meal. 26 Under the provisions of the Meals Act, 1906-14, the feeding of necessitous school children was continued as heretofore at the Municipal Restaurant. Dinners and breakfasts were provided at a cost of 3d. and 2½d each respectively. During the year 25,238 dinners, and 202 breakfasts were supplied to 394 children, suitable cases being selected by the medical officers, school teachers, nurses and attendance officers. The menus in use are submitted weekly to the medical officer, and I am happy to be able to state that our every suggestion has received the kind attention of the Treasurer, who is in charge of the Municipal Kitchen. (12) SCHOOL BATHS. With the exception of the Special School and Park Modern school, which are provided with spray baths, no baths exist in any of the other schools. In connection with verminous conditions and scabies, baths and disinfestations are provided at the cleansing station. Public swimming baths in East Street, belonging to the Council, are available for children attending the elementary schools on certain weekdays during part of the year, when swimming instruction is given. (13, (14), (15) & (16) CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE ' OFFICERS, AND VOLUNTARY BODIES. The attendance of parents at the medical inspections throughout the year was 62.7 per cent., compared with 60.7 per cent, in 1926. The teachers take a kindly interest in the work of medical inspections in spite of the interruption entailed, and their help is most valuable, while communication and mutual assistance are constant between the medical staff and the school attendance department. The number of parents actually refusing medical examination during the year was 21, as compared with 29 last year. It would probably be found, if these cases were investigated, that in several, 27 if not most, of them, examination could be undertaken under one or another section of the Act, but the public generally are so wholehearted in support of the School Medical Service it would not be politic to use compulsory powers in a scheme which is largely voluntary. The following is a brief resume of the work done by the Society for the Prevention of Cruelty to Children in the district during the year:- Total number of cases investigated 14 (a) Neglect 10 (b) Ill-treatment 1 (c) Advice, etc. 3 (d) Proceedings instituted — The work of the Society for the Prevention of Cruelty to Children is, as its name implies, essentially preventative, and only in exceptional circumstances, and where all other means have failed, are proceedings instituted. The work of this Society deserves every support by the public. It undertakes work it would be difficult for any public body to carry out, and the way in which the Society discharges its duties commends it. There are no Children's Care Committee, the additional duties which are usually carried out by such voluntary bodies, being carried out as far as possible by appropriate Sub-Committees of the Education Authority. After-care Committees have been formed in connection with all schools. (17) BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. (a) Children subjects of the above defects are ascertained through routine medical inspection or in more severe cases necessitating school absence through the activities of attendance 28 officers, the information so acquired being passed to the school medical officer, when any subsequent arrangements necessary for the child's disposal are made. Arrangements exist whereby exceptional children may. if necessary, attend non-residential certified schools or classes outside the district, and 7 deaf and dumb children so attended at Frederick Road Centre, Custom House, during the year. The number of blind and deaf children maintained at residential institutions during the year was 2. The number of blind and deaf children in this district is insufficient to justify the provision of special classes for these defects locally. The number of known epileptics of all grades is 13. Unless the defect is of quite a minor character (when the child may attend an ordinary elementary school), epileptic children can only be satisfactorily educated in special residential schools or colonies. Where epilepsy is combined with mental defect, the disposal of such cases is difficult, since few institutions throughout the country are prepared to receive them. The question of mentally sub-normal and mentally and physically defective children was considered at length in my predecessor's Report for 1924. During the year, suspected mentally sub-normal and backward children were referred from various elementary schools to a temporary class at the Special School, and subsequently after a few months' observation submitted for more detailed examination by the School Medical Officer. During the year 8 such children came before the School Medical Officer, out of which number, and including those whose period of observation expired during the year, 6 were certified mentally deficient, and arrangements made for their admission to the special class for such children. Mentally Defective Children.—9 children were examined as to their mental condition during the year, all of whom were certified educable and arrangements made for their admission to the special class. 29 The number of physically defective children in attendance at the cripple class was 38; 4 cases left the class on attaining the age of 16 years, whilst 14 cases left the class for other reasons. The School Medical Officer examined and certified 5 cases suitable for admission to the cripple class. (b) Ineducable mentally defective children of school age come within the responsibility of the Essex County Council. (c) The question of the after-care of mentally defective children, i.e., after attaining the age of 16 years becomes the statutory duty of the Local Control Authority, and is carried cut by the Essex County Council who arrange for guardianship or institutional care in necessary cases. Though no provision had until recently been made for the after-care of blind or deaf children or cripples, an after-care Committee has now been formed for that purpose. (18) NURSERY SCHOOLS. There are no nursery schools in the district. (19) SECONDARY SCHOOLS. The only secondary school in the district is the Abbey School, which comes under the Essex County Council. The arrangement whereby routine inspection at this school was carried out by the School Medical Officer of the district has been discontinued. It seems invidious that many of the children passing from your elementary schools to the secondary school should lose the benefit of your very comprehensive scheme of medical inspection and treatment, and further it appears obvious that unless or until the County are in a position to supply an equally comprehensive scheme, arrangements should be made for this work to be carried out by your Authority. (20) CONTINUATION SCHOOLS. There are no continuation schools in the district. 30 (21) EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. Milk and newspaper deliveries, general errands, hawking and newspaper selling are the usual forms of employment of children and young persons. In accordance with the Bye-laws of the Education Authority, 5 applicants of school age submitted themselves for examination prior to employment, of which number it was unnecessary to refuse any applicant on medical grounds. Street trading is permissible to boys of 15 years, although licence is refused girls under 16 years, :io prior medical examinations being required of applicants. Certain conditions, however, such as mental defect, prevent street trading being engaged in. (22) SPECIAL ENQUIRIES. No special enquiries were undertaken during the year. (23) MISCELLANEOUS. Two young persons, who desired to become bursars and student teachers, where medically examined during the year by a private medical practitioner, none being rejected on medical grounds. 31 REPORT OF THE ORTHOPÆDIC CLINIC. Orthopaedic Clinic, Faircross School, Barking, Essex. To the School Medical Officer. The Orthopaedic Clinic during this year has shown an increase in every way. Thirty-eight school children and eighteen children under school age were examined by me for the first time during the year, my findings being as follows:- SCHOOL CHILDREN. Deformities—Bones and Joints— (a) Congenital: (i) Congenital dislocation of hip 3 (b) Acquired: (i) Fractures 3 (ii) Derangement—knee joint 1 (iii) Arthritis—hip joint 1 (iv) Genu Valgum 4 (v) T. B. Spine 1 Muscular Deformities— 13 (а) Congenital: (i) Torticollis 2 (b) Acquired: (i) Pes Piano Valgus 5 (ii) Kyphosis 1 (iii) Scoliosis 1 Paralysis— 9 (d) Congenital (i) Hemiplegia 2 (ii) Diplegia 2 (iii) Spastic Gait 1 (iv) Pseudo-hypertrophic Muscular Paralysis 1 (b) Acquired: (i) Anterior Polio Myelitis 3 9 32 Congenital Abnormalities— (i) Absence of Pectoralis Major 1 (ii) Absence of Clavicle 1 (iii) Morbis Cordis 1 3 Various— (i) Inguinal Hernia 1 (ii) T.B. Glands 2 (iii) Alopecia 1 4 Total 38 CHILDREN UNDER SCHOOL AGE. Deformities—Bones and Joints— (a) Congenital: (i) Digit 3 Foot R. and L. 1 (ii) Webbed Digits 1 (b) Acquired: (i) Rickets 6 (ii) Genu Valgum 1 9 Muscular Deformities— (a) Congenital: (i) Talipes 3 (ii) Amyotonia 1 (b) Acquired: (i) Pes Planus Valgus 1 5 Paralysis— (a) Congenital: (i) Tetraplegia 1 (b) Acquired: (ii) Anterior Polio Myelitis 2 3 Congenital Deformities— (i) Congenital weakness in neck muscles 1 1 Total 18 33 127 school children and 29 children under school age were re-examined by me during the year. The following operations have been carried out:- (i) Torticollis 2 (ii) Sprengel's Shoulder 1 (iii) Tarsectomy, etc. 1 (iv) Tenotomy—Tendo Achillis 2 (v) Tenotomy of Adductors 1 (vi) Left Inguinal Hernia 1 Total 8 The successful results of the operations, particularly the cases of Torticollis, and the early treatment of Congenital Talipes in infants have been the special features of the work during 1927. B. WHITCHURCH HOWELL, F.R.C.S. 34 REPORT OF DENTAL SURGEON. To the School Medical Officer. I have pleasure in hereunder presenting you with a report of the Dental Department of the Municipal Clinic for the period during the last year in which the position of Dental Surgeon to the Council has been filled by me. Routine of Work. It is with gratification that it can be stated that, not alone, has the work gone smoothly, but also that the time for treatment has been used to the utmost extent. Occasions have occurred where treatment has been accepted, yet appointments for such treatment have not been kept. To obviate loss of working time in this respect these conditions are now being considered with a view to formulating some scheme whereby the department will still be able to be fully busy when such circumstances occur in the future. The department is working with a view to completing the circuit of school treatment in the shortest time and it is hoped, if it be possible, to thereby have the routine circuits of treatment more frequently. This objective remains, however, to be governed by the amount of work found to be undertaken, and the consents of the parents to have it done. Number of cases selected at Inspections for Treatment. When studying the statistics, a large percentage of this class would at first sight be apt to convey the impression that the oral hygiene due to the teeth must be classified as bad. It should be pointed out, however, that in the best attended dentition decay may occur and unfortunately invariably does, in the course of the year, but though it does, this does not necessarily place the mouth in the class of bad hygienic condition, for the dentition, apart from requiring one filling or two, may be otherwise perfect. Yet such cases go to making the percentages high. On an average the oral hygiene due to the teeth, in the inspections made, has appeared to be very good. In cases where it has not been quite as satisfactory 35 as could be expected, the cases have generally been those where treatment has not been accepted before, or where treatment was not accepted when last inspected. Filling of Deciduous Teeth. By reason of the contrast in the numbers so treated now as compared with the treatment prior to my appointment it seems imperative that some comment be made. This treatment is actuated by the fact of the great importance that the retention of the deciduous teeth are to be the position which the permanent teeth come to ultimately occupy, and is in addition to the importance of the masticatory machinery so necessary to the growing child. Though filling of the deciduous teeth is a process somewhat longer than that of extraction it is at the same time considerably shorter than the filling of a permanent tooth. If the point of time therefore is alone to be considered, this process seems to be most fully justified. Co-operation with the Schools. An effort is now in being whereby appointments are made to minimise as far as possible the loss of school time to the child in attending for dental treatment. Parents or Guardians attending Clinic with Children for Treatment. Every effort is made to stimulate interest in the importance of the care of the teeth. The seeking of information and advice from the department is at all times strongly encouraged and the reasons for the various treatments readily and fully explained. Nature of Treatment to be done. At the present time in appointments being made a distinction is made between "cases of extractions under gas" and "cases of fillings and extraction under local anaesthetic." It does unfortunately very much depend upon what the condition is found within the tooth in preparing it for filling before it can definitely be stated whether the tooth is saveable or not. Exceptions to this are, of course, teeth which are in a condition for which it is obvious extraction is the only treatment. On every occasion where any form of treatment is particularly objected to at the Clinic, the full reasons for such treatment having been intended is made clear. 36 At the same time too if there is any special objection by the parent, conformity is made with their wishes so far as it is possible to the work. It should also be stated that a nurse, well informed in the general clinic routine and treatment, visits all the parents from whom refusals for treatment are received, and endeavours to remove the cause of objection and to obtain consent, explaining at the same time that the dental surgeon at all times is ready to discuss and advise. Kindness and courtesy, it is hoped, does in some measure alleviate the dread of attendance. H. S. SMYTH, L.D.S., R.C.S. (Eng.), Dental Surgeon. 37 BARKING TOWN URBAN DISTRICT COUNCIL. SCHOOL MEDICAL SERVICE. TABLE 1.—RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Code Group Inspections: Entrants 918 Intermediates 483 Leavers 566 Total 1967 Number of other Routine Inspections 193 B.—Other Inspections. Number of Special Inspections 89 Number of Re-inspections 1574 Total 1663 38 TABLE II.—A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1927. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. . Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition 12 13 2 - Uncleanliness — — - - Skin Ringworm—Scalp 1 — - - Body 2 - - - Scabies 8 — - - Impetigo 3 — 2 - Other Diseases (NonTuberculous) 6 - 6 - Eye Blepheritis 8 — 3 - Conjunctivitis 1 — 1 - Keratitis - — — - Corneal Opacities — — — - Defective Vision (excluding Squint) 66 10 26 3 Squint 7 1 1 - Other Conditions 4 2 2 - Ear Defective Hearing 1 — 2 - Otitis Media 9 - 2 - Other Ear Disease 6 1 3 — Nose and Throat Enlarged Tonsils only 17 35 1 — Adenoids only 7 8 2 — Enlarged Tonsils and Adenoids 107 164 2 - Other Conditions 6 20 3 1 Enlarged Cervical Glands (NonT.B.) - 24 - 1 Defective Speech — — 1 2 Teeth—Dental Diseases (See Table IV., Group IV.) Heart and Circulation. Heart Disease : Organic - 23 - 1 Functional — 29 — — Anæmia 5 11 4 — Lungs Bronchitis 16 29 2 — Other Non-Tuberculous Diseases 3 4 1 — 39 TABLE II.—Continued. Defect or Disease. Routine Inspections. Special Inspections No. of Defects. No. of Defects. Requiring Treatment Requiring to be kept under observation, but not requiring Treatment Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Tuberculosis Pulmonary: Definite - - — — Suspected - 16 — — Non-Pulmonary: Glands 5 13 — — Spine — - - — Hip - - - — Other Bones and Joints - 1 - - Skin — — - — Other Forms — — — — Nervous System Epilepsy - — 1 — Chorea — 3 1 — Other Conditions 2 - 1 — Deformities Rickets - - — — Spinal 1 -| — — Other Forms 11 8 1 1 Other Defects and Diseases 14 33 5 2 40 B.—Number of Individual Children FOUND AT Routinf MEDICAL INSPECTION TO REQUIRE TREATMENT (EXCLUDING UNCLEANLINESS AND DENTAL DISEASES). Group. Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment CODE GROUPS : Entrants 918 149 16.23 Intermediates 483 69 14.28 Leavers 566 85 15.01 Total (Code Groups) 1,967 303 15.4 Other Routine Inspections 193 8 4.1 41 TABLE III.—RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Boys. Girls. Total. Blind (including partially blind.) (I.) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind - - - Attending Public Elementary Schools - - - At other Institutions - — — At no School or Institution - — — (II.) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind Attending Public Elementary Schools - 1 1 At other Institutions — - — At no School or Institution — - — Deaf (including deaf and dumb and partially deaf.) (I.) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 3 5 8 Attending Public Elementary Schools - - - At other Institutions - — — At no School or Institution - - - (II.) Suitable for training in a School or Class for partially deaf. Attending Certified Schools or Classes for the Deaf - - - Attending Public Elementary Schools - - - At other Institutions — — — At no School or Institution — — — Mentally Defective Feeble Minded cases not notifiable to the Local Control Authority. Attending Certified Schools for Mentally Defective Children 23 23 46 Attending Public Elementary Schools - - - At other Institutions __ - — At no School or Institution — — — Notified to the Local Control Authority during the year. Feeble minded - - - Imbeciles — 1 1 Idiots - - - Epilepsy. Suffering from severe Epilepsy. Attending Certified Special Schools for Epileptics - 2 2 In Institutions other than Certified Special Schools - - - Attending Public Elementary Schools - - - At no School or Institution — 1 1 Suffering from Epilepsy which is not severe. Attending Public Elementary Schools 5 5 10 At no School or Institution — - — 42 TABLE III.—continued. Boys. Girls. Total. Physically Defective. Infectious pulmonary and glandular Tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 2 1 3 At other Institutions — — — At no School or Institution —— —— — Non-infectious, but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools — - — At other Institutions — - At no School or Institution - - Delicate children (e.g., pre- or latent tuberculosis. ' malnutrition debility, anaemia, etc.) At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools 62 63 125 At Public Elementary Schools 6 5 11 At other Institutions — - — At no School or Institution - - —— Active non-pulMonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 2 2 4 At Public Elementary Schools — - — At other Institutions — — — At no School or Institution — — — Crippled Children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc. and including those with severe heart disease. At Certified Hospital Schools - - - At Certified Residential Cripple Schools - - - At Certified Day Cripple Schools 24 14 38 At Public Elementary Schools — - — At other Institutions — - — At no School or Institution - 1 1 43 TABLE IV.—TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. Skin:— Ringworm—Scalp 9 - 9 Body 25 - 25 Scabies 23 2 25 Impetigo 290 1 291 Other Skin Diseases 135 1 136 Minor Eye Defects 120 6 126 (External and other, but excluding cases falling in Group II.) Minor Ear Defects 125 18 143 Miscellaneous 330 1 331 (e.g., minor injuries, bruises, sores, chilblains, etc.). Total 1,057 29 1,086 44 Group II.—Defective Vision and Squint (excluding Minor. Eye Defects Treated as Minor Ailments—Group I.) Defect or Disease. Under Authority's Scheme. Number of defects dealt with. Submitted to refraction by private practitioner or at hospital apart from the Authority's Scheme. Otherwise Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) 137 35 172 Other Defects or Diseasesof the eyes (excluding those recorded in Group I.) — — Total 137" 35 ' 172 Total number of children for whom spectacles were scribed:— (a) Under the Authority's Scheme 126 (b) Otherwise 35 Total number of children who obtained or received spec tacles:— (a) Under the Authority's Scheme 126 (b) Otherwise 35 Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of treatment. Total number treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 239 48 287 15 302 45 GROUP IV.—Dental Defects. (I) Number of Children who were:— (a) Inspected by the Dentist. Routine Age Groups— Age 3 - 4 20 5 621 6 866 7 761 8 470 9 464 10 506 11 599 12 593 13 492 14 116 15 7 Total 5515 (b) Found to require treatment 3092 (c) Actually treated 2193 (2) Half-days devoted to Inspection 44 Treatment 347 Total 391 (3) Attendances made by children for Treatment 2377 (4) Fillings—Permanent Teeth 743 Temporary Teeth 150 Total 893 (5) Extractions—Permanent Teeth 311 Temporary Teeth 3562 Total 3873 (6) Administrations of General Anaesthetics for Extractions 497 (7) Other Operations—Permanent Teeth 136 Temporary Teeth 46 GROUP V.—Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurse 3 (ii) Total number of examinations of children in the schools by School Nurses 18367 (iii) Number of individual children found unclean 2081 (iv) Number of children cleansed under arrangements made by the Local Education Authority 184 (v) Number of cases in which-legal proceedings were taken:— (a) Under the Education Act, 1921 - (b) Under School Attendance Bye-laws 4