BARK 72 Borongh of Barking THE ANNUAL REPORT OF THE School Medical Officer For the Year 1930. C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L R.C.P., D.P.H. 116 TABLE OF CONTENTS Pages BLIND CHILDREN 148, 149 CHICKEN-POX 133 CLINIC ATTENDANCES 134,135,139, 140 CONTINUATION SCHOOLS 152 CO-ORDINATION AND CO-OPERATION 121, 147 CRIPPLING DEFECTS AND ORTHOPEDICS 132,139,140,141 DEAF CHILDREN 148, 149 DEFECTIVE FOOTGEAR 129 DENTAL DEFECTS 132, 138, 141 DIPHTHERIA 133 DRYING FACILITIES 122-123 EAR DISEASE 130, 138 EMPLOYMENT OF CHILDREN AND YOUNG PERSONS 152 EPILEPTIC CHILDREN 148, 149 EYE DISEASE 129, 137, 138 FAIRCROSS SCHOOL 145 FOLLOWING-UP WORK 134 HEIGHTS AND WEIGHTS 129 INFECTIOUS DISEASE 132, 133 INTRODUCTION 119 MALNUTRITION 126 MEASLES 133 MEDICAL INSPECTION AND FINDINGS 124, 125, 126, 127 MEDICAL AND SURGICAL TREATMENT 135, 136 MENTAL DEFECTIVE CLASS 149, 150, 151 MENTALLY DEFECTIVE CHILDREN 148. 149 MINOR AILMENTS 129, 134, 135 NATIONAL ASSOCIATION FOR PREVENTION OF CRUELTY TO CHILDREN 148 NURSERY SCHOOLS 151 OPEN-AIR EDUCATION 142, 144 OPEN-AIR SCHOOLS 144 PHYSICAL TRAINING 145, 146 117 Table of Contents.—Contd. Pages PLAISTOW CHARITY NURSES 135, 136 PLAYGROUND CLASSES 142 PNEUMOCONIOSIS 152 PROVISION OF MEALS 122,146 REPORT OF THE DENTAL SURGEON 157, 158 REPORT OF THE ORTHOPEDIC CLINIC 154, 155, 156 SCARLET FEVER 133 SCHOOL BATHS 143, 147 SCHOOL CAMPS 143 SCHOOL HYGIENE 121, 132 SCHOOL JOURNEYS 142, 143 SCHOOL VENTILATION 133 SECONDARY SCHOOLS 151 SKIN DISEASES 129, 137 SPECIAL ENQUIRIES 152, 153 STAFF 118,121 STATISTICAL TABLES 159-169 STUDENT TEACHERS AND BURSARS 153 TONSILS AND ADENOIDS 130,136 TUBERCULOSIS 131, 136 ULTRA-VIOLET LIGHT TREATMENT 137, 144 UNCLEANLINESS 127 VISION AND SQUINT 129, 130, 138 WHOOPING COUGH 133 118 SCHOOL MEDICAL STAFF, 1930 School Medical Officer : C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. Assistant School Medical Officers : J. GWEN BEVAN, B.Sc., M.R.C.S., L.R.C.P. HILDA C. DEAN, M.B.B.S., M.R.C.S., L.R.C.P., D.P.H. Orthopaedic Surgeon: 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: W. H. FOY, L.D.S., R.C.S. (Eng.) Masseuse: Miss A. E. FINDLAY, C.S.M.M.G. Nurses: Miss L. F. SWAIN (h) and (i). Miss S. E. W. GIBSON (j). Miss G. GEDEN (Dental Nurse). Clerical Staff: E. W. HILL, (Resigned Feb, 1930). Chief Clerk F. READ (Commenced June, 1930). D. G. TONKIN. Miss V. SHEAD. Miss H. NUNN. Miss H. KING. A. J. STORER. (h) Certificate of Central Midwives' Board (i) General Hospital Training. (j) General Fever Training. 119 Barking Town Urban District Council. PUBLIC HEALTH OFFICES, BARKING, ESSEX. May, 1931. To the Chairman and Members of the Local Education Authority. Mr. Chairman, Ladies and Gentlemen, It is one of the most important duties of your Medical Officer to submit to you an annual report on the public medical services you maintain, and this is the fourth such report I have had the honour to submit to you. These annual reports are apt to be very dry reading, but they contain a lot of useful information and are .drawn up to comply with the requirements of the Board of Education. The year 1930 has been a very important one in the history of Barking, and, in addition to the importance of this report from 120 the standpoint of its being a review of the work we are presently undertaking, it is also very important in that it shows the beginning of those developments in your public .medical services which are taking place owing to the growth and development of the town— particularly the growth and development of the London County Council Becontree Estate. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, School Medical Officer. 121 ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER For the Year 1930. (1) STAFF. The staff responsible for the school medical services carried out by the Council is shown on a separate page at the beginning of this report. The increase in staff is due to the increased duties which have fallen upon the department. (2) CO-ORDINATION. You have achieved a very real measure of co-ordination between the various public medical services administered by the Council, but there must of necessity be some difficulty in maintaining these services at maximum efficiency so long as the responsibility for running them is shared by two important Committees of the Council. (3) SCHOOL HYGIENE. The fact that you have a building programme of approximately £400,000 gives you a glorious opportunity in these new schools of giving sanitary circumstances the attention to which they are entitled, and which they certainly did not receive when the old schools were being built. The background of a child's school life is the permanent screen on which he or she will focus the later environment in the factory, in the workshop and in the home, and the silent lesson of hygienic circumstances at school is the most precious thing a child will ever receive from school life. I trust that no one will be prepared to carry out over-crowding in these schools. This may minimise cost; it will be prodigal extravagance., 122 I trust also that adequate arrangements will be made for the children's boots and clothes to be thoroughly dried whenever necessary, and that further provision will be made for habits of cleanliness, such as bathing, etc., to be enforced. It is not suggested that provision should be made for every child to bathe and clean his teeth, etc., at school, but there should be ample provision at school for this to be carried out where otherwise the children will not be educated in these very essential habits of cleanliness. The time, too, has come when the provision of adequate means of drying the children's clothes and boots in the older schools should not be longer delayed. Rheumatism is one of the prevailing diseases in Barking, and damp clothes must contribute to the incidence of this disease. It is difficult to over-estimate the economic loss to the country from the prevalence of rheumatism, and providing proper drying accommodation at school would not only do something of itself towards preventing the incidence of rheumatism, but it would also be a silent teacher witnessing to the need of similar provision on all occasions. Provision of Meals.—May I call your attention to the fact that last year I suggested to you that the time had come when the temporary buildings in which the children were given these meals should be replaced by a better and bigger building? This is a matter I know you have very much at heart, and I do appreciate the difficulties which you will have to face in dealing with the problem, but it is a problem which does not brook delay and I would seriously recommend to you that the present arrangements have outlived their usefulness and that a better, brighter building, with increased amenities, should be provided forthwith. It is my duty to iterate and to reiterate that perhaps there is no department of education of more social, hygienic and economic advantage than that which deals with table manners, and that whether children congregate at the food centre or whether they partake of their meals at their own schools, these mealtimes should be the occasion of intensive educational training. 123 There is, perhaps, no factor to-day which tends to make persons more conscious of any deficient education than the recognised want of table manners. The inability to speak as an educated person may be mitigated by discreet silences, but coarse table manners cannot be hidden and are a definite hindrance to social life, and— what is even worse—they are very bad from a medical standpoint. The following table shows the number of children who do not return home for the mid-day meal, and if and whether facilities are provided for them. It also shows what facilities, if any, exist for the drying of children's clothes and boots. 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— 40 Yes Yes C. of E. Boys — No School fires in winter only. Girls — „ „ Infants - „ „ Ripple— Boys - „ „ Girls — ,, „ Infants — „ „ SS. Mary & Ethelburga Mixed 29 „ „ St. Joseph's Infants 30 Yes „ Gascoigae Boys - No „ Girls — ,, „ Infants — „ „ Westbury Boys — „ „ Girls — „ Yes—at Laundry School fires in winter only. Infants — „ North Street— Boys — „ „ Girls — „ „ Infants — „ „ Castle— 18—20 Small stove in teachers' private room. School fires in winter only. Faircross— All children stay at school for mid-day meal, the food being supplied from Municipal Kitchen Yes Yes Cambell— Senior Infants — No. No. — „ „ 124 This table, showing as it does how inadequate are the facilities you have provided for the drying of children's clothes and boots, makes very sorry reading. It is idle to talk of building extra classrooms to afford children special educational facilities and of building extra schools and departments without at the same time making provision for looking after the children while they are at school, and the drying of boots and clothes is a very important matter—so important that no school can be looked upon as efficient where this provision is not adequate. I recommend you earnestly to give this matter your immediate attention. (4) MEDICAL INSPECTION. Sir George Newman, in his Annual Report for the year 1929, begins by saying "The foundation of the school medical service is the systematic and routine medical inspection of all the children in attendance at public elementary schools, whether sick or well." It is only from the results of such inspection that you can know how far you are catering for the needs of the school population and what special services are required to deal with the disabilities which are found in the course of these inspections. During the year the number of children inspected in the specified age groups was 2,467, together with 234 other routine inspections, making a total of 2,701, or 40.2 per cent. of those in average attendance. In addition 225 children were examined at special inspections. These were referred to your doctors by their parents, by the school teachers or by the nurses. Thus 2,926 children have passed under medical review during the year. This is 43.6 per cent. of the average attendance. 125 In Barking we visit most of the schools three times a year for the purpose of these school medical inspections, but I have stressed elsewhere the need there is for medical officers to visit schools on their own initiative and at the request of Head Teachers, apart from these routine visits, and I do hope that Head Teachers will from time to time consult my department on those matters of hygiene and sanitation which come within the purview of your medical officers. The table herewith included, which is a modification of Table IIB to be found in the appendix to this report, shows the number of children who have been examired and the number of defective children referred either for treatment or for observation during the years 1929 and 1930. Entrants Intermediates Leavers Specials Other Routine Examinations Total 1929 1930 1929 1930 1929 1930 1929 1930 1929 1930 1929 1930 No. of children examined 914 949 958 975 572 543 162 225 339 234 2945 2926 No. referred for treatment 129 155 156 176 76 90 51 69 14 23 426 513 No. referred for observation 251 281 198 255 104 140 67 122 1 3 621 801 Percentage of defective children 41.6 45.9 37.0 44.2 31.5 42.4 72.8 84.9 4.4 11.1 35.6 44.9 The following table shows the percentage of the children examined who were accompanied by their parents or guardians. Year. Percentage of Children Examined who were Accompanied by Parents. Year. Percentage of Children Examined who were Accompanied by Parents. 1925 65.5 1928 64.8 1926 60.7 1929 65.7 1927 62.7 1930 66.3 126 The number of children on the school register on 31st December, 1930, was 7,906, compared with 7,284 on 31st December, 1929. During the year, the Medical Officers paid 198 visits to 22 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. The following table shows the number of children examined at routine and special inspections during 1930, classified according to the schools attended, the number of inspections held in each school and the number of parents or guardians present:— School. No. of inspections. Numbers inspected. No. of Parents present. Boys. Girls. Park Modern 6 54 34 34 Gascoigne 35 259 253 328 North St. 28 242 197 284 Castle 4 25 37 40 Westbury 35 259 235 351 Ripple 26 206 204 311 Faircross 21 101 133 174 St, Joseph's and SS. Mary's and Ethelburga's 14 111 85 101 Church of England 17 113 98 111 Cambell 12 140 140 206 (5) FINDINGS OF MEDICAL INSPECTIONS. Table II on page 160, gives in detail a return of defects found during the course of routine inspection. The figures in brackets are the comparable figures for last year. (a) Malnutrition.—It is my happy position to be able to continue to report to you that malnutrition is not a serious problem in Barking. The number of cases referred for treatment has gone down nearly 50 per cent., and I attribute the increased number 127 referred for observation to the fact that our standard has been raised. It is a happy thought that you are doing all that you are doing to feed school children wherever necessary. (b) Uncleanliness. — With reference to uncleanliness, the significant figures are to be found in Table IV, Group V, on page 169. In October, 1930, my report on uncleanliness for the year 1929 was very seriously considered by the Council, who decided that the suggestions contained in pages 13 and 14 of that report be carried into effect. This is a decided step forward on which, if I may, I would like to tender my heartiest congratulations. There is no hardship whatsoever in proceeding with every coercive measure you have to enforce absolute- cleanliness so far as infestation amongst boys is concerned. Last year I said " I do not see why every boy with an infested head should not be excluded forthwith, and the parents proceeded against," and you in your wisdom have decided to accept this recommendation. Similarly I take it you have decided, in conformity with my recommendation of last year, that in any circumstances—including therefore the case of girls—where cleansing is undertaken by the Local Authority in default, a prosecution shall follow. Although the situation with regard to uncleanliness in Barking is one on which I have written strongly from year to year and one which still requires strong language adequately to represent the situation, I want to make it perfectly clear that the teachers and the nurses in Barking are doing very real work and that the problem in Barking is only the same as it is in all other similar towns. 128 The whole situation is overshadowed by the fact that a large number of people are living under circumstances which are such that only a continual warfare against infestation can possibly maintain cleanliness in this direction, and these very self-same distressing circumstances are such as to make it unlikely that the parents of these children will maintain the persistent effort without which cleanliness cannot be attained or retained. A relatively small proportion of such cases in any town is likely to infest quite a large number of children because they provide a constant source of infestation, which renders other children unclean whose parents are doing quite sufficient to keep their children clean if it were not for this constant infestation. School. Dept. No. of Examinations Nits only. Nits and Vermin (head) Gascoigne Infants 1170 96 4 Boys 1434 30 1 Girls 1322 188 11 North St. Infants 982 57 1 Boys 1088 17 2 Girls 1062 84 6 Castle Infants 452 49 — Boys Girls Westbury Infants 1216 78 7 Boys 769 13 — Girls 1242 120 7 Ripple Infants 1127 61 3 Boys 793 18 1 Girls 1174 116 3 C.of E. Infants 550 81 2 Boys 420 17 1 Girls 420 112 2 St. Joseph's Infants 705 98 7 SS. Mary's & Boys 668 50 1 Ethelburga's Girls Cambell Infants 939 73 21 Senior Faircross — 454 44 — Park Modern Mixed 460 5 3 129 Defective Footgear.—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 196 cases, compared with 193 in 1929. In all, 217 children were supplied with boots during the year. (c) Heights and Weights.—The following table gives the average heights and weights of children examined at the three undermentioned age periods in all of the schools, compared with the results at similar age periods in 1926, 1927, 1928 and 1929. Year. Average Height in Inches. Average Weight in Pounds. 5 yrs. 8 yrs. 12 yrs. 5 yrs. 8 yrs. 12 yrs. 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 1928 42.1 49.5 57.2 40.2 56.4 81.2 1929 41.9 50.5 5G.3 40.9 56.3 83.5 1930 43.5 49.9 57.2 42.6 57.5 82.9 Average for 5 years 42.4 49.8 57.1 40.9 55.5 82.0 (d) Minor Ailments.—The number of minor ailments found at routine medical inspection is not large. This does not mean to say that there is not a fairly large number of cases in Barking, but that they are picked up promptly by your teachers and by your nurses and that they are dealt with at your Minor Ailment Clinics, so that when it comes to the children being examined at routine medical inspection the numbers actually found at such inspections are favourable. (e) & (f) Skin Disease and Eye Disease.—Similarly, with skin disease and eye disease, the number of cases actually found at routine inspections is small. (g) Vision and Squint.—The number of cases of defective vision showed an increase last year on the then previous year and 130 shows a further increase this year. The number of cases found must, of course, go up with the increased school population, but I think there is an actual increase as well as a relative increase. This is an increase which has to be watched, because it might mean that the circumstances under which children are being educated are likely to produce eye strain. I do not think, however, that the evidence is sufficient to warrant such an opinion being held. (h) Ear Disease.—The number of cases of ear disease, too, shows an increase on last year. This is also being watched. (i) Tonsils and Adenoids.—Last year you were advised that the number of cases of tonsils and adenoids showed then an increase. It is my duty to report this year a further actual and relative increase in the number of these cases. The time is fast approaching when children having their tonsils out will become almost a routine. For my part, I want to make it perfectly clear that these cases are seen by at least two doctors before the operation is performed, in which circumstances it must be admitted that the operations are not lightly undertaken. Thus your School Medical Officers find out that a child has enlarged tonsils and they decide as to if and whether they think it will be right for the child to be operated on. Our routine practice is then to send the child up for interview at the Queen Mary's Hospital, Stratford, where the child is examined by a specialist before an appointment is made for the operation to be carried out. In addition to this, the children are often seen by a third doctor, because a large number of children have been observation cases before they become cases which are put down for treatment. It seems therefore that you are taking every possible precaution against this operation being carried out unnecessarily. My own opinion, as I have told you, is that these enlarged tonsils are due largely to errors of diet. There is too much sameness about children's food; they want more brown bread and fresh 131 fruit and vegetables than they are getting at present. Fortunately, a large number of children are getting milk, because you have established a scheme for milk being provided through the schools. (i) Tuberculosis.—There were 14 cases of tuberculosis amongst children of school age notified to the Medical Officer of Health during the year. Of these two were pulmonary and twelve w-ere non-pulmonary. The following table shows the position with regard to notification of tuberculosis amongst children of school age during 1930: Notified during 1930 Pulmonary 2 Non-Pulmonary 12 Total 14 De-notified (of the above) Pulmonary — Non-pulmonary — Total — As reported elsewhere, the revision of the Tuberculosis Register has now been going on for some time, and during the year under review the following numbers of school children have been removed from the Notification Register. Removed from Register. Pulmonary. Non-Pulmonary. Cured 1 6 Amended Diagnosis 36 26 Left District — 2 Died — — Total 37 34 132 (k) Dental Defects.—The general findings of routine medical inspection demonstrate the value of the dental services you have inaugurated. What has to be said this year is said in the Report of the Dental Officer and a more complete statistical review will be submitted next year when owing to the increased services we shall have a fuller opportunity for inspection. (1) Crippling Defects.—Crippling defects are happily only infrequently found during routine medical inspections, and a number of these are of a relatively minor character. Your orthopaedic service, allied to the orthopaedic service carried on by the Public Health Committee has done really useful work. (6) INFECTIOUS DISEASE. The problem as to if and whether infection tends to be spread more by ordinary school life than by closing schools and allowing the children to run wild is a perennial one, and the general consensus of opinion at the present time is that the closing of schools is on the whole to be deprecated. It is pointed out that unfortunately the sanitary circumstances of school life, even where these are not what we would wish them to be, are better than those of home life, and that, even although a certain amount of infection may be spread at school, this is negligible compared with what would be spread in the homes, particularly where the infectious disease is one which is commonly treated at home and where home isolation is impracticable or otherwise is not likely to be efficiently carried out. It is also suggested that by keeping the children at school they can be kept under more careful observation and cases of infectious disease detected earlier than they would otherwise be, to the advantage of the community and of the individual. This advantage depends entirely on the relative merits of the sanitary circumstances of school life compared with home life, and if therefore the present tentative opinion in favour of keeping schools open is to be consolidated, it behoves everybody to see that school life represents a higher level of sanitation than home life, even when home life has the advantages of the more modern housing circumstances found on your own and on the London County Council estates. 133 The chief thing to aim at in your schools is adequate ventilation, and the school curriculum, at least during periods of epidemic when any infectious diseases are likely to be prevalent, should be so arranged that children are never in one classroom for more than fifty minutes or so, and that for the remainder of the hour the classroom is literally flushed with sufficient air and the windows and doors opened to the maximum extent. One very great difficulty in combating the incidence of infectious disease is that the public do not know the normal appearance of the various parts of the body that are likely to be affected. I have had the temerity to suggest that the senior scholars might with advantage learn to draw one another's throats and other similar organs which are likely to be the seat of disease. It is not suggested that they should learn the long, complicated Latin names of all the various parts they would draw, nor that they should in the least be told what these anatomical parts look like when they are diseased, but that they should know what they look like when they are healthy. A good housewife when she rejects a potato because it is diseased does not know the name and the nature of the particular disease from which the potato is suffering. She knows it is a bad potato, and in the same way children should be. taught the normal healthy appearance of various parts of the body so that they may know when there is any deviation from the normal. Where the attendance of a school falls below 60 per cent. and in the opinion of the Medical Officer this bad attendance is directly due to the prevalence of infectious disease, the school sessions so affected are not counted in estimating the average attendance for the purpose of grant. During 1930 one certificate was granted for this purpose. The following table shows briefly the number of children notified and reported suffering from some of the commoner infectious discases:- 1927 1928 1929 1930 Scarlet Fever 117 132 164 91 Diphtheria 39 67 44 202 Measles and German Measles. 1 342 191 283 Chicken-pox 166 Whooping Cough 99 262 378 89 134 (7) FOLLOWING UP. A summary of the "following up" work undertaken by your school nurses is given herewith:— Number of visits to schools for medical inspection 177 Total number of visits to schools 373 Number of home visits in connection with:— 1928 1929 1930 (a) Routine medical inspections 3345 3549 4759 (b) Infectious disease 571 520 660 (c) Uncleanliness inspections 212 80 119 (d) Non-attendance for treatment (Minor Ailments, etc.) 542 124 406 (e) Dental Inspections — 460 406 (f) House to house visits, Gale Street area - - 145 It will be noted that visits in connection with dental inspection and treatment are included in the above table for the second year. Following up dental cases is now done by the health visitors and school nurses as well as by the dental nurse, who only does visiting during certain holiday times. Clinics.—The numbers of school children attending in 1929 and 1930 were as follows:— Clinic. No. of 1st attendances of children. Total No. of attendances. 1929 1930 1929 1930 Minor Ailments (a) Central Clinic 2139 2456 10757 12068 (b) St. Alban's — 128 - 1230 Ophthalmic 139 182 482 738 Dental 951 818 2997 3138 Ringworm 15 4 30 8 Orthopaedic FOR EXAMINATION 28 37 2997 2693 FOR TREATMENT 32 78 135 Minor Ailments Clinic. Central Clinic St. Albans 1920 1930 1930 No. of days clinic was open 331 349 49 Total No. of attendances 10757 12068 1230 Daily average attendance 32.5 34.6 25.1 No. of cases treated 2139 2456 128 (8) MEDICAL AND SURGICAL TREATMENT. Minor Ailment Clinic.—The arrangements for the treatment of minor ailments have remained substantially the same as for last year, except that the St. Alban's Clinic was opened on November 5th, 1930. This is a temporary clinic held in the St. Alban's Church Hall. We are very happy in being able to make some arrangements for the people in this area, but the circumstances under which the clinic is held are rather primitive and, so soon as practicable, it is hoped that the clinic will be housed in a suitable building. Every attempt is made to conduct this work without any encroachment on private practice, and I think the evidence of our work here goes to show that the work we are carrying out promotes the financial and professional interests of private medical practitioners. This clinic in Barking meets a very real need. The number of attendances have gone up again this year very considerably, and altogether you are to be congratulated on this essential work you are so carefully carrying out. I have discussed ways in which even this clinic could be improved upon by continuous medical supervision, and in some measure this has been achieved during the year on which I am reporting, but there still remains for us to arrange for continuous nursing supervision. The present system of staffing these clinics altogether from the Plaistow Charity means that the nursing staff is continually 136 changing, and this is not in the best interests of the clinic. I think that the time has come when we should consider having at Jeast one full-time nurse at each clinic, the same to be on the permanent staff of the Council. Tonsils and Adenoids.—Operations for the surgical treatment of tonsils and adenoids are carried out by arrangement with Queen Mary's Hospital, Stratford, and St. Mary's Hospital, Plaistow. From time to time I have submitted that children should be detained in hospital for some days after the operation has been performed for the removal of tonsils and adenoids. This operation is not such a minor one as is commonly supposed. It entails not only the physical derangement consequent on an anaesthetic and loss of blood, but also constitutes a real shock to the nervous system. I advise you to make arrangements for children to be received into hospital at least the afternoon of the day preceding the operation and to remain in hospital three days after the operation Tuberculosis.—The treatment of tuberculous children is in the hands of the County Council. As I said last year, there is a lot of overlapping. The diagnosis of tubercle in children similarly is in the hands of the County Council and this leads to even still further overlapping. In the case of diagnosis, the consequences of this overlapping are at present to a certain extent mitigated by your own Medical Officer being Tuberculosis Officer, and, although it may be somewhat farcical, the one officer playing a sort of "Box and Cox" all by himself, sometimes being Medical Officer of Health and sometimes being Tuberculosis Officer, this system has worked moderately well, but the idea of a separate Tuberculosis Officer under the County and not under yourself undertaking this work is not a sound one for such a compact administrative unit as Barking. 137 Skin Diseases.- The treatment of skin diseases is still one which ranks very highly in economic worth so far as the efficiency of your school service is concerned, because it is minor ailments of this nature which causes an undue loss of time by exclusion from school. These cases are treated at your Minor Ailment Clinic, and cases of ringworm of the scalp are treated away from your Minor Ailment Clinic by Dr. A. Kennedy. Although the cases of ringworm and of scabies have gone down, the number of cases of impetigo dealt with has gone up roughly from 300 to 400 cases. This increase in the number of cases of impetigo is out of proportion to the increase in the school population. After deducting a small number of cases of impetigo which to all outward manifestations are impetigo but yet are probably very different from ordinary impetigo and do not readily yield to treatment I am of opinion that the vast majority representing the other cases are in part at least due to home circumstances. If only parents would bring their children to the Clinic right away and would actually carry out the treatment offered, we should see but a very small fraction of the number of serious cases of impetigo with which your officers have to deal. We intend using ultra violet light for the intractable cases which form a small proportion of the whole, and for the rest we must appeal to the parents of these children for more active co-operation. It is to be regretted that we often find these cases returning day after day with the dressings entirely removed, and oftentimes come to the opinion that the dressings have only been on for a very small fraction of the day. External Eye Disease.— Although the number of minor eye defects treated this year has gone up from 70 to 118, I am happy to be able to say that the nature of these defects remains essentially 138 minor and we have not come across other than very few cases which have not responded readily to treatment. Vision.— The treatment of defective vision shows an increase from 103 in 1929 to 138 in 1930. As for last year, this treatment is carried out by one of your medical officers at the East Street Clinic, and the increased work done not only represents increased school population but represents an increased interest in the care of the eyesight by all those who are responsible for the welfare of the children. Ear Disease.—The treatment carried out at your clinic is the ordinary medical treatment and a large number of ears respond readily to this treatment, but there are a few where the cause of the trouble is deep seated and the treatment more specialised than that which can be carried out at an ordinary Minor Ailment Clinic. Once again I advise you to entertain the possibility of appointing a special aural surgeon, who would attend in the first instance, say once a month during term time. Dental Defects.—The treatment of dental defects is dealt with specially in a part of this report prepared by Mr. Foy, the dental surgeon. It does seem an enormous pity that the public will not take seriously professional appointments made by their own public authorities. No professional public man or woman in practice could make a success of life, do what is right by his patients, and live an economic life if his patients constantly failed to keep appointments. This, however, is what happens at public consultation centres. For instance, we feel ourselves working about an average when anything up to two-thirds of the appointments turn up. The result is that we are torn between two difficulties. On the one hand, a reasonable number of patients are asked to attend, and the service is 139 - 140 PARTICULARS OF WORK DONE IN CONNECTION WITH ORTHOPAEDIC 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 School Children Under Age 11 240 37 43 150 83 2506 1392 2693 1518 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 3 47 1 9 45 1695 18 806 — - 11 102 Under School Age ! 9 172 — - 7 101 114 1066 2 9 24 192 Admission to Orthopaedic Hospitals On waiting List for Admission 31/12/30. School Children Under School Age Total School Children Under School Age Total 7 8 15 — - — 141 uneconomic because only about two-thirds of this reasonable number turn up. On the other hand, an extraordinary number of cases are asked to turn up in the hope that a reasonable number will do so, and the curious thing is that when this is done, almost every case keeps the appointment and, in addition, a number of casuals attend. In these circumstances, the work can only be done with great strain on the practitioner, which is neither good to him nor the patients, or, alternatively, some of the patients have to be turned away, which is hardly ever done because such a procedure is bad for the clinic. It is to be hoped that the public will remember that it is their money which is being spent on these Clinics, and it is our responsibility to see that it is spent economically, and that we cannot do this unless people will look upon appointments made in the public service just as seriously as they would look upon other professional appointments. Crippling Defects and Orthopaedics.—The treatment carried out for cripples in Barking has been in the past and still is very good. Mr. Whitchurch Howell attends once a month and Miss Findlay on three whole days a week. This service, however, does not cope adequately with all the work we have at the present time, and will be far short of what is necessary in the immediate future. Last year I seriously urged you to increase your orthopaedic work, and I advise you that forthwith provision should be made for the equivalent of the services of a whole-time orthopaedic nurse. The premises, too, where this work is carried on are unsatisfactory. There should be waiting room accommodation to replace the draughty corridor in which so many people have to wait at the present time, and to prevent the overcrowding, particularly on Wednesday afternoons, we have in the one room available. There should also be proper accommodation for the children to undress and dress.+ 142 (9) OPEN AIR EDUCATION. Playground. Classes.—May I call attention to the comments I made last year with regard to open air education? This is an aspect of the educational life of a child which is not sufficiently entertained by those who are responsible for looking after children. Everything seems to militate against education in the open air— the construction of the schools, the construction of the furniture, books and stationery, and I am almost tempted to believe, the necessary nature of the curriculum as understood by the representatives of the Board of Education. From a hygienic standpoint there can be no question but that the rule should be for classes generally to be held in the open air, with the building as a refuge only when circumstances make this impossible. It is a very wrong thing for children to be brought up with the idea that the house is the natural environment of man. When one sees the fine results of open-air treatment at sanatoria there is certainly an inclination to look upon houses as only a necessary evil. This is perhaps stretching the situation unduly, but there can be no question we do not do enough in the open air, and the glorification of home life has led to the glorification of the house, to the detriment of open air life. School Journeys.—The following school journeys were made by scholars during 1930:— Date. School. Place Visited. June, 1930 North St. Boys' School Stratford-on-Avon. (7 days). (30 boys) June, 1930 Church of England Girl's Yarbridge, Isle of Wight. (10 days) School (22 girls) Sept., 1930 Westbury Boys' School Sandown, Isle of Wight. (15 days) (30 boys) Aug.-Sept., Ripple Boys' School Sandown, Isle of Wight. 1930 (30 boys) (15 days) 143 The total cost of these journeys did not exceed £350. You will remember that last year I reminded you that the question of school journeys on a much more comprehensive basis than then obtained was being considered by you, and this year it is pleasant to note that the list of school journeys represents a much more ambitious and comprehensive programme. School Camps.—School camps are run during the week-ends from Friday to Monday evening. The camp is of a permanent nature and is situated at Hainault. Thirteen Camps were held during the year, in which 624 Scholars participated. During the summer holidays, too, there are additional camps where children are taken for a fortnight at a time to the same huts at Hainault. School camps are a step in the right direction, leading to an appreciation of the open-air life of which I have spoken above. Indeed, it seems to me the time is fast coming when in large metropolitan areas the possibility of extending these camps for weeks and months on end might be entertained. The idea of a school being a wondrous piece of architecture that one hundred years hence will form a glorious epitaph to the people who built it must be broken down. A school is essentially a number of scholars, with an adequate number of teachers, and so impressed am I with the strides which have taken place in open-air education that I am persuaded a very full educational programme could be drawn up to be carried out in a holiday encampment which would surpass any of the present curricula as an educational measure and at the same time promote the health, happiness and wellbeing of the children. The idea that such camps must of necessity be costly is, I believe, unfounded. Providing the children are healthy, are adequately clothed and properly fed, the material part of such an establishment could be—and perhaps should be—of a very simple, inexpensive nature. 144 Open-air Classrooms in Public Elementary Schools.—Modern architecture is tending towards the erection of classrooms which can be turned into open-air classrooms. A lot, however, yet remains to be done in this direction, and I am happy to note that we are moving in the right direction in the new schools which are being built. Ultra Violet Light Treatment.—Ultra violet light treatment has been carried out at Faircross School during the year, the total cases treated being 18. The period of treatment of these cases varied from one month to twelve months and the total number of doses was 806. Children diagnosed as suffering from Tuberculous Glands, Alopaecia, Rheumatism, Anaemia. Debility, Impetigo and Cervical Adenitis are among those who have derived considerable benefit from this treatment. It has been found possible during the year under review to provide increased medical supervision for this work, but the whole question of ultra violet treatment in Barking requires revision and I am submitting a separate report on this matter. (10) OPEN-AIR SCHOOLS. Once again, in discussing the question of Open-air Schools, 1 want to speak of the futility of building an Open-air School, staffing it and equipping it for its special work and then using it only for about 25 hours in the week. The ladies and gentlemen of the Council and its Committees who visit the Open-air School rejoice with me in the good work it is carrying out, but I cannot help feeling that we are spending a lot of money to obtain results which represent a small return for the money expended, when the expenditure of more money would bring an increased return out of all proportion to the extra expense. Our aim, of course, is to make Open-air Schools unnecessary, but this involves work by the Council on housing, etc., as well as work by the Education Committee of the Council, but so long as 145 Open-air Schools are necessary I feel that 25 hours a week for about 44 weeks in the year is not a sound financial proposition. The following table shows the position with regard to recommendation and admission to Faircross School during the year. School. Recd. Adm. Refused Waiting Adm. Deferred Left District Westbury 22 12 e 4 — — North Street 14 9 l 2 1 1 Ripple 16 10(1) l 5 — 1 Gascoigne 25 22(2) l 4 — — C. of E 9 5 2 2 — — St. Joseph's & St. Ethelburga's .. 3 1 — 2 — — Castle 1 1(1) — 1 — — Cambell 4 3 1 — — — No School 19 17 — 2 — — Totals 113 80(4) 12 22 1 2 N.B.—Small figures in brackets indicate the number of children recommended for admission in 1929 but admitted in 1930. (11) PHYSICAL TRAINING. The Local Education Authority have no officer with special. duties for organising physical training in your schools. It has been my good fortune to take a spectator's interest in some of the activities which are carried out amongst our school children, and a few of the opinions I now hold are worth recording for future reference. Where team games such as football are played, the size and shape of the ground is of very great importance, and varying sizes are required for children of different ages who may be taking part. 146 If a game of Rugby is being played by junior boys, it is of advantage for the field to be relatively short. This, however, is by no means obligatory. It is, however, obligatory that the field should be relatively narrow, so that the boys may find touch fairly constantly, with consequent brief intervals in the strenuous game. The aim is essentially to prevent undue strain. Children are capable of enormous output of energy for a short time. Thus young hoys are able to snatch easy runs at cricket who would be completely fatigued even walking round a golf course with quite old men. For this reason races which are to be run should be short and races around the 300 yard mark—comparable with the 440 yards of the adult athlete—should be avoided altogether, because they are the most strenuous of all races. (12) PROVISION OF MEALS. Whereas, in 1929, 33,991 free meals were provided, during 1930, 31,556 meals were provided. With the active co-operation of all your officers concerned I find it difficult to believe that there are any children who of necessity go without a square meal some time during the day. I look upon this work as one of the finest you are carrying out and trust that the good work which is being undertaken will soon be carried on in adequate accommodation. As you know, the building in which these children are at present fed has been inadequate now for some time. (13) SCHOOL BATHS. Last year I expressed the hope that baths would soon be found in every school, and that certainly provision would be made in every new school opened by the Local Education Authority. 147 It is not sufficient to provide houses with baths; it is also . necessary to bring up a generation to whom bathing is a natural habit. The development of this natural habit is an essential part of education and should form part of every sound educational scheme. The old joke of the bath at home being used as a coal cellar is played out, but the reality that lies behind this sordid joke, though by no means so true as it used to be, is still true, and whilst children who ought to have a bath are allowed in school without having a bath, the necessity for bathing will never be realised. Once more I want to say that the skin is an organ of the body as much as the liver, and if it is not kept active it gets sluggish and will not carry out its functions. Bathing not only removes dirt and allows the skin to function, but stimulates it to function—not only the bathing, but the friction of drying with the towel and the exposure of the body to the atmosphere. There are public swimming baths at East Street. These belong to the Council. Children attending elementary schools are instructed in swimming at these baths, and here is a healthy exercise which should be encouraged. The provision of a public swimming pool in the park should do a lot, not only towards promoting cleanliness, but towards getting people into the habit of stimulating themselves by bathing. I do hope that the day is not far distant when there will not be one boy or girl in Barking who is not able to swim. (14), (15), (16) and (17) CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. We are fortunately able to continue to express our appreciation of the interest that parents take in routine medical inspection; no 148 less than 66.3 per cent. of the children examined being attended by their parents or guardians. The teachers, too, have continued to take the remarkable interest they have hitherto shown in this work. The routine medical inspections afford a splendid opportunity for co-operation between the teaching and the medical staff. Last year I pointed out that routine medical inspection is a census of the health of the school population, and that for the purposes of this census we must examine everybody who comes within the categories laid down by the Board of Education. It is just as essential for us to have the healthy people on this census list as the unhealthy, and therefore we want to examine those who are in perfect health quite as much as the others. I am credibly informed that the National Society for the Prevention of Cruelty to Children have dealt with 18 cases. The following table shows the way in which these cases have been dealt with:— Total number of cases investigated 18 . (a) Prosecutions 1 (b) Warnings 14 (c) Otherwise dealt with 3 In addition to the above, the local inspector, so I am advised, has paid 126 supervisory visits. (18) BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. We continue to report to you the number of these cases you have, but, with you, we regret that there is no sufficient accommodation throughout the country to deal with these cases after they have been found out and classified. It is obvious to me that if these children are to be housed in suitable institutions, each institution accommodating, so far as practicable, children with the same degree of disability, mental or physical, these institutions require to be of a national character. 149 This is particularly so in institutions catering for children with more than one disability, for whom at the present time accommodation is particularly limited. I do hope that you will take every step possible towards this end, which is, I am persuaded, the only solution of the present difficulty. Six deaf and dumb children have attended at Frederick Road Centre, Custom House, during the year. No deaf and dumb child has been maintained in a residential institution. One blind child has been maintained in a residential institution. During the year under review one child aged five years was admitted to the Frederick Road Centre. The number of known epileptics of all grades is six. Mentally Defective Class, Open Air School.—The problem of mental deficiency is much more difficult than was at one time understood. Actually we have been dealing with children who are educationally backward, but this is in reality a different thing from mental deficiency, which is a much wider term. Once again I want to refer to the children who can only and do only acquire scholarship under the constant stimulus of an educational system. Just as in medicine we learn our most significant lessons in the post mortem room, so in education much may be learned from the study of the mentally defective children. These mentally defective children can be taught to do a marvellous number of things. The difficulty is that you cannot teach them to "be" anything. 15 They may cut out and they may sew, they may dress and they may learn parts of a play and they may carry through an evening's entertainment to the wonderment and delight of audiences, and nevertheless they have no sufficient dynamic urge to carry out an hour's consecutive work demanding the least personal initiative. Many of these children, if left to themselves, would merely sit about in odd corners twirl their fingers, make grimaces, probably foul themselves, and be altogether objectionable. Between these children and the normal and bright children there is every grade, and there can be no doubt that many children who under the constant stimulus of our educational system acquire information at such a rate that they may be looked upon as more or less ordinary children, who are nevertheless mentally defective from this standpoint, that they have not a sufficient dynamic urge. To these children the end of school life is something more than the end of acquiring information—it is the beginning of a definitely backward tendency, and before long these children are but little better than if they had had little or no education at all. If our educational system is to be efficient and economic we must not only deal with the problem of the child who is both mentally defective and educationally backward; we must also deal with the problem of the child who is not specially educationally backward but who notwithstanding this is inherently mentally defective. In what way the educationalist would deal with the problem I do not know and I for my part would not be so bold as to suggest a method of dealing with this difficulty, but I may perhaps be allowed to suggest a line required, and that is that all children of a certain age, to be decided upon, shall be given a certain period of time during which class teaching shall stop and individual study take its place with the least possible degree of supervision, and that amongst other things, children be graded according to their educational response during this experimental period. 151 The real trouble is that our educators are too efficient. Under their skilful tuition a high grade mentally defective child can go through the whole curriculum without being discovered. (19) NURSERY SCHOOLS. There are no nursery schools in the district. As the Committee know, I am not so enthusiastic about nursery schools as are, some people. "Nursery schools are required for small children who cannot get personal attention where the home is squalid, where food is bad ard insufficient, where the only playroom is the gutter, and where ill health passes unnoticed till chest trouble, rickets or other ailments have developed "—Sir George Newman. It is my earnest suggestion that the real solution of this problem is to make the homes fit for these children to live in. A comprehensive housing scheme on the one hand and the beneficial results of modern education on the other should make nursery schools as such unnecessary. Nursery schools may be classed with the curative treatment in medicine, whereas the whole idea of a public medical service is prevention. (20) SECONDARY SCHOOLS. Once again I want to point out how invidious it is for children leaving your ordinary elementary schools to proceed to a higher education to be debarred from the very comprehensive medical services you have set up. It has so far proved itself impracticable for the County Council to offer amenities similar to your own. The difficulties they would find in setting up such services would be considerable, but there is no doubt that there is a very real need for the children to be looked after in the way in which you look after your own children, and I 152 do hope that during the next year something will be done along the lines of the County handing over the whole of this work to you, whatever the. financial consideration involved may be. (21) CONTINUATION SCHOOLS. There are no continuation schools in the district. (22) EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. Milk and newspaper deliveries, general errands, etc.. are the usual forms of employment of children and young persons. In accordance with Rye-laws of the Education Authority, 30 applicants of school age submitted themselves for examination prior to employment, of which number it was necessary to refuse five applicants on medical grounds. Street trading is permissible to boys of 15 years, although licence is refused girls under 16 years, no prior medical examinations being required of applicants. Certain conditions, however, such as mental defect, prevent street trading being engaged in. (23) SPECIAL ENQUIRIES. There have been no special enquiries within the meaning of the Board of Education. The work we have been doing on industrial pneumoconiosis has been of great interest to the Local Authority, particularly to the Juvenile Employment Sub-Committee. There is much more work waiting to be done, and it is unfortunate that the services available are only sufficient for the ordinary day to day routine. 153 I do feel that not only in Barking but throughout the whole of the country much good would accrue if all services were sufficient for reasonable time to be allowed for independent research. (24) MISCELLANEOUS. No young persons who desired to become bursars and student teachers were medically examined during the year by a private medical practitioner. This closes the report for the year 1930. 154 REPORT OF THE ORTHOPAEDIC CLINIC. Orthopaedic Clinic, Faircross School, Barking, Essex. May, 1931. To the School Medical Officer. The Orthopaedic Clinic has again shown an increase in numbers, more particularly in the primary examinations, both of school children and also those under school age. The numbers are as follows:— School Children. Under School Age. Primary Examinations 37 43 Re-examinations 150 83 The findings of the primary examinations are as follows:— SCHOOL CHILDREN. 1. Deformities—Bones and Joints— (a) Congenital— (i) Amputation of Forearm 1 (b) Acquired— (i) Fractures 2 (ii) Arthritis 1 (iii) Genu Valgum 4 (iv) Genu Varum 1 (v) Rickets cum Epilepsy 1 2. Muscular Deformities— (a) Congenital— (i) Talipes 1 (ii) Torticollis 1 155 (b) Acquired— (i) Pes Piano Valgus 5 (ii) Kyphosis 7 (iii) Lordosis 1 (iv) Kypho-lordosis 1 (v) Scoliosis 1 3. Paralysis— (a) Congenital— (i) Cerebellar Ataxia 1 (b) Acquired— (i) Anterior Poliomyelitis 3 (ii) Injury to Wrist 1 CHILDREN UNDER SCHOOL AGE. 1. Deformities—Bones and Joints— (a) Congenital— (i) Webbed Digits of Feet 1 (b) Acquired— (i) Bow Legs 9 (ii) Genu Valgum 15 (iii) Genu Varum 1 2. Muscular Deformities— (a) Congenital— (i) Torticollis 2 (ii) Haematoma-Sterno-Mastoid 5 (iii) Talipes 1 (b) Acquired— (i) Pes Planus 13 3. Paralysis— (a) Congenital— (i) Spastic Hemiplegia 1 (ii) Cerrebellar Ataxia 1 156 (b) Acquired— (i) Anterior Poliomyelitis 3 (ii) Paresis of Thigh Muscles 1 During the year seven school children and eight children under school age were admitted to hospital. The following operations have been carried out:— (a) School Children— (i) Open elongation Tendo Achilles .. 6 (ii) Cuneiform osteotomy femur (right and left) 1 (iii) Stoffel's operation—median and ulnar nerves (Hemiplegia) 1 (iv) Manipulation of foot and plaster splint 2 (b) Children under School Age— (i) Osteoclasis (right and left) 2 (ii) Cuneiform osteotomy femur (right and left) 2 (iii) Tenotomy Tendo Achilles 1 (iv) Manipulation of foot and plaster splint 1 Total 16 The special features of this year's work are the increased number of children under school age sent up for examination. The treatment advised was carried out, except in a few cases where the parents have refused or did not attend regularly with their children. B. WHITCHURCH HOWELL, F.R.C.S. 157 REPORT OF DENTAL SURGEON. May, 1931. The Medical Officer of Health, Barking Town Urban District Council. Sir, I have the honour to submit the annual report on the School Dental Service for the year 1929-1930. At the commencement, attention is called to the small number of schools examined during the year. In explanation it is to be noted that in the past it was customary to make school examinations with frequency and by rota irrespective of the number of children waiting for treatment. This led to an accumulation of children examined but not treated, the number examined considerably exceeding the number treated. At the commencement of the year 1929 over two thousand children who had been examined were awaiting treatment, and it was considered administratively and professionally necessary to lessen considerably this number before proceeding with the examination of further schools. Attention is also drawn to the fact that there has been considerable reduction in the extraction of both temporary and permanent teeth. In this respect teeth that would have been condemned in the past have been submitted to treatment by routine applications of ammoniacal solution of silver nitrate with extremely gratifying results, 80 per cent. of teeth that might have proved unsavable without such treatment having been usefully retained. The frequency of dental caries in this country is out of all proportion to the knowledge of preventive dentistry at the disposal of the population. A consideration of dental disease should commence not when the first infant tooth appears but so soon as a mother becomes pregnant, under advice obtained at ante-natal clinics, or from attending practitioners. A diet plentiful in calcium salts and those accessory food substances known as vitamins should be taken 158 by the prospective mother; a diet rich in bone making and protective elements. Such a diet is available to the poorest, certainly to all people of Barking, and advice on such selected foods is given, the simplest and most easily procurable foods being recommended. Most domestic dietaries contain them, but, unfortunately, their more frequent use is hindered by prepared foods made more palatable or easier of preparation but lacking in food value. Eggs, milk, butter, cheese, herrings, sprats, vitaminised margarine for those who cannot afford butter, liver, carrots, tomatoes, watercress, are all of excellent vitamin A and D value, and could be assisted by fish roes and cod liver oil. It is interesting to notice the improvement in the hardness of decayed areas in the teeth of under-age children treated at this clinic when put on cod liver oil for six months, and in this respect it is quite proper to regard the administration of vitamin D not only as a preventive but as a cure in cases not too far advanced. Parents should also realise that the dreaded pyorrhoea of adult life is a deficiency disease contracted in childhood and manifested in later life, and its prevention can be effected by a diet rich in vitamin A. From the very spare list given above of food of sound dietetic value it seems that dental disease should prove a rapidly decreasing disease, but it is a matter that needs broadcasting to the people of Barking as much as other places if the present dental condition of young mothers and young children is to be accepted as a criterion of the dental-mindedness of the population. My thanks are again due to the Medical, Nursing, Visiting and Teaching Staffs for their excellent co-operation and propaganda work during the year, work which has proved itself by the considerably lessened number of refusals and by the increasing number who favourably reconsider a first refusal. I am, Sir, Your obedient Servant, W. H. FOY, L.D.S., R.C.S. (Eng.), Public Dental Officer. Barking Town Urban District Council. 159 SCHOOL MEDICAL SERVICE. TABLE I.—RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Code Group Inspections: Entrants 949 Intermediates 975 Leavers 543 Total 2467 Number of other Routine Inspections 234 B.—Other Inspections. Number of Special Inspections 225 Number of Re-inspections 2633 Total 2858 160 TABLE II. (A)—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1930. 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) (8) Malnutrition 7 41 6 Uncleanliness — — — — Skin Ringworm—Scalp — — — — Body — — — — Scabies 1 — — — Impetigo 6 — 1 — Other Diseases (NonTuberculous) 5 2 1 1 Eye Blepheritis 2 — — — Conjunctivitis 2 — — — Keratitis 2 — 1 — Corneal Opacities — — 1 — Defective Vision (excluding Squint) 122 68 18 7 Squint 14 16 6 3 Other Conditions 1 — — — Ear Defective Hearing 4 — 3 2 Otitis Media 12 3 2 1 Other Ear Disease — — 1 — Nose and Throat Enlarged Tonsils only 143 229 8 7 Adenoids only 6 8 1 1 Enlarged Tonsils and Adenoids 82 90 9 4 Other Conditions 3 6 2 I Enlarged Cervical Glands (NonTuberculous 1 61 — 12 Defective Speech 1 2 — 3 Teeth—Dental Diseases 72 (found, but not referred) (See Table IV., Group IV.) Heart and Circulation. Heart Disease: Organic — 21 — 3 Functional — 41 — 10 Aniemia 6 10 1 1 Lungs Bronchitis 8 55 2 4 Other Non-Tuberculous Diseases 1 6 1 3 161 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 r Pulmonary: Definite — 2 — — Suspected — 3 — — Non-Pulmonary: Glands — 5 — 2 Spine — — — — Hip — — — — Other Bones and Joints — — — — Skin — — — — Other Forms — 1 — — Nervous System Epilepsy — 2 — 1 Chorea — 3 — 3 Other Conditions 1 2 — — Deformities Rickets — 2 — — Spinal Curvature 13 8 1 2 Other Forms 5 15 3 3 Other Defects and Diseases 10 62 8 54 162 TABLE II.—Continued. (B.)—Number of Individual Children FOUND AT Routine 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 (1) (2) (3) (4) CODE GROUPS: Entrants 949 155 16.4 Intermediates 975 176 18.1 Leavers 543 90 16.6 Total (Code Groups) 2467 421 17.1 Other Routine Inspections 234 23 9.8 163 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 — 1 1 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 2 3 5 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution 1 — 1 (II.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf — — — Attending Public Elementary Schools — — — At other Institutions — — — . At no School or Institution — — — Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority.) Attending Certified Schools for Mentally Defective Children 29 20 49 Attending Public ElementarySchools 1 1 At other Institutions — — — At no School or Institution — — — Notified to the Local Control Authority during the year. Feeble-minded See Form 307M Imbeciles Idiots Epileptics. Suffering from severe Epilepsy. Attending Certified Special Schools for Epileptics — 1 1 In Institutions other than Certified Special Schools — — — Attending Public Elementary Schools — — — At no School or Institution — — — Suffering from Epilepsy which is not severe. Attending Public Elementary Schools 2 3 5 At no School or Institution — — — 164 TABLE III.—continued. Boys. Girls. Total. Infectious pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board of Education 1 1 2 At other Institutions — — — At no School or Institution — 1 1 Non-infectious. but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board of Education 2 — — At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — 1 1 At Public Elementary Schools 1 — 1 At other Institutions — 1 1 At no School or Institution — 1 1 Physically Defective. Delicate children (e.g., preor latent tuberculosis, malnutrition debility, anaemia, etc.) At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools 53 73 126 At Public Elementary Schools 11 10 21 At other Institutions — — — At no School or Institution. — 1 1 Active non-pulmonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board of Education 2 1 3 At Public Elementary Schools — — — At other Institutions 1 — 1 At no School or Institution 1 — 1 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 22 17 39 At Public Elementary Schools — — — At other Institutions — — — At no School or Institution 1 1 2 165 FORM 307M. — STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1930, BY THE LOCAL EDUCATION AUTHORITY TO THE LOCAL MENTAL DEFICIENCY AUTHORITY. Total No. of Children Notified A nalysis of the above Total. 3 Diagnosis. Boys. Girls. 1 (i) Children incapable of receiving benefit or further benefit from instruction in a Special School:— (a) Idiots — — (b) Imbeciles — — (c) Others 1 — (ii) Children unable to be instructed in a Special School without detriment to the interests of other children:— (a) Moral Defectives — — (b) Others 1 — 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 1 3. Feeble-minded children notified under Article 3, i.e., "special circumstances" cases — — Note.—No child should be notified under Article 3 until the Board have issued a formal certificate (Form 308M) to the Authority. 4. Children who in addition to being mentally defective were blind or deaf — — Note.—No blind or deaf child should be notified without reference to the Board—see Article 2, proviso (ii.) GRAND TOTAL 3 — 166 TABLE IV.—TREATMENT TABLE. GROUP 1.—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 1 2 3 4 Skin:- Ringworm—Scalp 3 — 3 Body 9 — 9 Scabies 5 — 5 Impetigo 400 2 402 Other Skin Diseases 75 4 79 Minor Eye Defects 118 8 126 (External and other, but excluding cases falling in Group II.) Minor Ear Defects 107 4 111 Miscellaneous 1798 2 1800 (e.g., minor injuries, bruises, sores, chilblains, etc.). Total 2515 20 2535 167 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). Operations for Squint should be recorded separately in the body of the report 138 50 - 188 Other Defects or Diseases of the eyes (excluding those recorded in Group I.) - — — — Total 138 50 - 188 Total number of children for whom spectacles were pre scribed:- (a) Under the Authority's Scheme 137 (b) Otherwise 34 Total number of children who obtained or received spectacles:— (a) Under the Authority's Scheme 135 (b) Otherwise 34 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) 314 67 381 12 393 168 GROUP IV.—Dental Delects. (1) Number of Children who were:— (a) Inspected by the Dentist. Routine Age Groups— Age 5 23 6 164 7 169 8 153 9 175 10 203 11 166 12 162 13 191 14 239 Total 1645 Specials 74 Grand Total 1719 (b) Found to require treatment 1352 (c) Actually treated 3138 (d) Re-treated during the year as the result of periodical examination 2320 (2) Half-days devoted to - Inspection 13 Treatment 363 Total 376 (3) Attendances made by children for Treatment 3138 (4) Fillings—Permanent Teeth 1166 Temporary Teeth 142 Total 1308 (5) Extractions- Permanent Teeth 300 Temporary Teeth 1869 Total 2169 (6) Administrations of General Anaesthetics for Extractions 704 (7) Other Operations- Permanent Teeth Temporary Teeth 1952 169 GROUP V.—Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses 3 (ii) Total number of examinations of children in the schools by School Nurses 18397 (iii) Number of individual children found unclean 1490 (iv) Number of children cleansed under arrangements made by the Local Education Authority 58 (v) Number of cases in which legal proceedings were taken:- (а) Under the Education Act, 1921 - (b) Under School Attendance Bye-laws - R9/71