PEN 9 THE TENTH ANNUAL REPORT of the School Medical Officer for the URBAN DISTRICT OF PENGE in the county of kent, for the Year ending 31st December, 1917. P. B. Beddow, " Press" Printing Works, Anerley, S.E. THE TENTH ANNUAL REPORT of the School Medical Officer for the URBAN DISTRICT OF PENGE in the COUNTY OF KENT, for the Year ending 31st December, 1917. P. B. Beddow, "Press" Printing Works, Anerley, S.E. Arban Distcict Council of Penge Education MEMBERS Chairman : Mr. R. B. Ransford, J.P. Deputy-Chairman : Mr. F. P. Hodes. MEMBERS OF THE COUNCIL. Mr. E. G. Hopper, J.P. (Chairman of the Council, ex officio.) Mr. S. H. Croucher. Mr. W. Dommett. Mr. H. Culver. Mr. G. J. Gully. Mr. F. P. Hodes. Mr. D. R. Keith. Capt. W. Marr. Mr. F. Walter Payne. J.P. Mr. J. W. Rudd. Mr. H. Wallis. Mr. W. C. Watling, J.P. REPRESENTATIVE MEMBERS. The Rev. Ernest J. Barson. Mr. A. F. Boyer. Mr. T. Clarke. Mr. R. B. Ransford, J.P. Mr. W. B. Tanner, J.P. Mr. W. M. Thompson. The Rev. S. M. Warner. Mrs. N. Watling. Mrs. B. M. Wilkinson. SCHOOL MEDICAL OFFICER. William Adams Clark, M.D. Lond., M.R.C.S., L.R.C.P. Eng. MEDICAL INSPECTORS. Ernest George Pringle, M.D. Lond., M.R.C.S., L.R.C.P. Eng. Arthur Scott Turner, M.R.C.S., L.R.C.P. Eng. SCHOOL DENTAL SURGEON. D. Harold Barr, L.D.S. SCHOOL NURSE. Miss M. Linford Brown. CLERK TO THE COMMITTEE. C. G. Liddle. The Town Hall, Anerley, S.E. To the Chairman and Members of the Education Committee of the Urban District Council of Penge. Ladies and Gentlemen, I have the honour of presenting to you the Tenth Annual Report on the Medical Inspection of children in attendance at the Elementary Schools in the district for the year ending December 31st, 1917. The report has been made according to the requirements of the Board of Education. Tables I., II. and IV. are inserted as before. Tables III. and V. are additional this year. The Schools under the control of the Education Committee are five in number, viz. :— Official No. 1. Melvin Road 2. Oakfield Road 3. St. Anthony's 4. St. John's, Croydon Road Maple Road 5. St. Paul's Built. 1881 1900 1898 1837 1861 1869 Accommodation. 1193 934 124 742 199 Average on Roll. 1129 1123 143 806 230 Average. Attendance. 949 957 121 687 188 The work of Medical Inspection has been carried out as in 1916. Dr. Scott Turner was absent on military duty throughout 1917 ; his work was done by his partner, Dr. Michael. Owing to the death of Mr. J. J. Ritson, L.D.S., the dental work has been carried out by Mr. Chas. A. Lightfoot, L.D.S., R.C.S. Edinburgh, in the continued absence (on military duty) of the School Dentist, Mr. H. D. Barr. TABLE I. Number of Children inspected 1st January, 1917, to 31st December, 1917. A " CODE " GROUPS. Entrants. Intermediate Groups. Leavers. Age— 3 4 5 6 Other Ages. Total. 8 12 13 14 Other Ages. Total Grand . Total Boys 16 56 129 38 . 135 374 133 153 33 3 0 189 696 Girls 16 47 104 50 96 313 157 98 3 0 0 101 571 Totals 32 103 233 88 231 687 290 251 36 3 0 290 1,267 B. Groups other than " Code." Intermediate Group other than 8 years. Special Cases. Re-examinations, (i.e., No. of Children re-examined.) Boys — 59 129 Girls — 57 66 116 195 6 Table II—Return of Defects found in the Course of Medical Inspection in 1917. Defect or Disease. Number referred for treatment. Code Groups. Number requiring to be kept under observation, but not referred for treatment. Number referred for treatment. Specials. Number requiring to be kept under observation, but not referred for treatment. Malnutrition 8 49 1 Uncleanliness : Head 56 175 1 Uncleanliness : Body 8 177 — Skin— Ringworm : Head 1 — 16 Ringworm : Body 1 — 7 Scabies 5 — 3 Impetigo 5 — 35 Other Disease 6 2 20 Eye— Defective Vision and Squint 46 20 8 External Eye Disease 4 12 12 Ear— Defective Hearing 12 32 — Ear Disease 3 16 5 Nose and Throat— Enlarged Tonsils 27 8 1 Adenoids 9 4 1 1 Enlarged Tonsils and Adenoids 17 7 — Defective Speech 2 9 — Heart and Circulation— Heart Disease: Organic 3 9 — Heart Disease : Functional 1 9 — Anaemia 1 12 — Lungs— Pulmonary Tuberculosis : Definite — — — Pulmonary Tuberculosis : Suspected — — — Chronic Bronchitis — 2 — Other Disease — 3 — Nervous System— Epilepsy 2 1 2 Chorea 1 — — Other Disease — — — Non-Pulmonary Tuberculosis : Glands 2 — 1 Bones and Joints 1 — 2 Other Forms — — — Rickets — 16 — Deformities 1 5 — Other Defects "or Diseases 1 11 — 7 8 This abbreviated Table gives a summary of the diseases found during routine medical inspection. In the column (3) are noted defects which are departures from the normal condition of health, but which are not sufficient to require treatment. The greater number of children sent as specials to the Medical Inspectors for diagnosis and advice are found to be suffering from some form of skin disease, and are usually referred for treatment to the Minor Ailments Clinic. The figures for cleanliness are not so good this year as in 1916 by 5 per cent. After the summer holidays the heads of some children were found to be in a very poor condition. It is suggested that this was due to the fact that the mothers were at work, and were consequently unable to give sufficient time to the care of these children. The children continue to be well fed and to be provided with better clothing and footgear. The free breakfasts which were given in this district during winters before the war were still not necessary, owing to employment being plentiful and to the allowances made for soldiers' children. Table III.—Numerical Return of all Exceptional Children in the Area in 1917. Boys. Girls. Total. Blind (including partially blind)— Attending Public Elementary Schools 2 1 3 Attending Certified Schools for the Blind — — Not at School Deaf and Dumb (including partially deaf)— Attending Public Elementary Schools — 5 5 Attending Certified Schools for the Deaf 2 1 3 Not at School — — Mentally Deficient— Feeble-Minded— Attending Public Elementary Schools 1 2 3 Attending Certified Schools for Mentally Defective Children Notified to the Local (Control) Authority during the Year — — — Not at School — Imbeciles— At School — — Not at School — — Idiots— — Epileptics— Attending Public Elementary Schools — — — Attending Certified Schools for Epileptics — 1 1 Not at School 1 (awaiting vacancy) Physically Defective— Pulmonary Tuberculosis— Attending Public Elementary Schools — 1 1 Attending Certified Schools for Physically Defective Children Other forms of Tuberculosis— Attending Public Elementary Schools 2 – 2 Attending Certified Schools for Physically Defective Children Not at School 2 — 2 Cripples other than Tubercular— Attending Public Elementary Schools 2 5 7 Attending Certified Schools for Physically Defective Children 1 Not at School — 1 1 Dull or Backward*— Retarded 2 years 5 19 24 Retarded 3 years — 4 4 * Judged according to age and standard. Table IV.—Treatment of Defects of Children during 1917. Condition. No. of defects found for which treatment was considered necessary. No. of defects for which no report is available. No. of defects treated. Results of Treatment. No. of defects not treated. Percentage of defects treated. From previous year. New Total. Remedied. Improved. Unchanged. Clothing 1 1 – – – – – – – Footgear 1 1 2 — 1 — 1 — — 100 Cleanliness of Head 19 56 75 11 47 16 31 — 17 62.66 Cleanliness of Body 1 3 4 1 3 2 1 — — 75 Nutrition — 7 7 — 6 3 — 3 1 85.71 Nose and Throat 19 47 66 13 28 15 13 — 25 42.44 External Eye Disease — 4 4 — 4 2 2 — — 100 Ear Disease 1 4 5 — 5 3 2 — — 100 Teeth — 9 9 1 6 6 — — 2 66.66 Heart and Circulation — 5 5 — 5 1 — 4 — 100 Lungs Nervous System — 2 2 — 2 — 2 — — 100 Skin — 6 6 — 6 4 2 — — 100 Rickets — — — — — — — — — — Deformities — 1 1 — 1 — 1 — — 100 Tuberculosis, Non-Pulmonary — 1 1 1 Speech — — — — — — — — — — Mental Condition 1 — — — — — — — — — Vision and Squint 20 41 61 4 39 36 — 3 18 63.93 Hearing — — — — — — — — — — Miscellaneous — 1 1 — 1 1 — — — 100 Total 63 188 250 31 154 89 55 10 63 61.6 vo 10 The voluntary attendance of the children at the Cleansing Station continues. In many cases the children regard the bathing as a treat, and look forward to it. In the few cases where compulsory cleansing has been required it has been carried out without the opposition that often arises under such circumstances. The children were again provided with cocoa after the bath by the kindness of a lady member of the Education Committee. The smooth working of the cleansing scheme reflects great credit on those engaged in carrying it out, and especially on the influence and tact of the School Nurse. No prosecutions took place in 1917. Treatment has been increasingly difficult to obtain for some conditions. In Eyesight cases the number which could be dealt with at Hospital was limited. In the Report for 1916 it was stated that the facilities for obtaining treatment at Hospital were diminished by one-half. From October 1917 onwards it was found impossible to obtain treatment without restrictions that made it unattainable for this district. Now arrangements have been made for treatment under Dr. Critchley at Croydon instead of at Guy's Hospital. The number of children requiring treatment at the end of the year was eighteen. In throat cases there was considerable reluctance on the part of mothers to take on themselves the responsibility of consenting to operation in the absence of the fathers on military service. Of the 66 throat cases requiring treatment, 28 were treated, 25 were not treated, and in 13 cases no report was available owing to the children having left the district. THE DENTAL CLINIC. To the Chairman and Members of the Education Committee of the Urban District Council of Penge. I have the honour to present to you the Fifth Annual Report on the work done in connection with the School Dental Clinic. This report deals with the inspection and treatment of the teeth of children between the ages of five and eight years. I undertook to act as deputy for Mr. Barr, L.D.S., on May 15th, 1917. I wish to acknowledge the great assistance and work of Nurse Miss Linford Brown. Table V. (1) The total number of children medically inspected (whether Code Group, special or ailing child) 1,267 (2) The number of children in (1) suffering from defects (other than uncleanliness, or defective clothing or footgear) who require to be kept under observation (but not referred for treatment) 227 (3) The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc,) 128 (4) The number of children in (3) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 83 11 Inspection of Children between Five and Eight Years. School. Number inspected. Number requiring treatment. Melvin Road 483 385 St. Anthony's 98 74 St. Paul's 86 79 Oakfield Road 265 225 Total 932 763 Clinics. Number of Clinics 42 Number of Visits of Children 746 Number of Teeth filled 249 Number of Teeth extracted 465 Chas. A. Lightfoot, L.D.S., R.C.S. Edin. Of the children inspected in 1917, 18" 1 per cent, had sound teeth : girls, 20 3 per cent. ; boys, 15 8 per cent. Of the children who required treatment, 51*2 per cent, attended for it. MINOR AILMENTS CLINIC. The Clinic, which was started in June, 1914, is held at Oakfield Road School on Fridays at 2.30 p.m. by Dr. Michael and Dr. Adams Clark as before. The numbers attending increase each year, and parents come with children more than formerly. Many children are sent direct to the Clinic by the Teachers. The attendances for 1917 are as follows :— Attendances. Blepharitis 60 Conjunctivitis 21 Otorrhoea 26 Impetigo 103 Sores 127 Scabies 54 Ringworm (Head) 156 Ringworm (Body) 44 Other Diseases 117 708 Under the heading " Other Diseases " are included cases requiring first aid, and some brought for diagnosis. Of the " Other Diseases " eczema is the most commonly met with. The attendances for Ringworm of the head have been 50 per cent, more than in 1916. Of the 29 cases treated during the year, 25 were cured, 2 left the district and 2 were under treatment at the end of 1917. Of the 25 cured cases, 18 were 12 treated by X-rays, and 7 were cured by drugs. Prejudice against the use of X-rays still exists in the minds of a few parents. The results of this form of treatment have been uniformly satisfactoty; this treatment is effective and rapid. Cases (especially those with scattered patches) which have been treated by drugs for twelve months have finally had recourse to X-rays. Usually the cases treated by X-rays have been cured and have returned to school within five weeks. Scabies was more prevalent in the latter part of the year. Children requiring small dressings or syringing of the ears have been seen by the School Nurse on Tuesday mornings. Review of the Action to Detect and Prevent the Spread of Infectious Disease. Measles was prevalent in the schools during the six weeks before Easter. The School Medical Officer consulted with the Medical Officer of Health, and it wr s decided to advise the closing of the Infants' Departments of all the Schools on Fridg y, March 30th, instead of on April 4th. This was done, and an interval of sixteen clear days before the holidays terminated was ensured. This postponed to the next term the usual passing of children from the Infants' Departments into the Boys and Girls' Departments, and the admission of fresh children into the Infants' Departments ; these changes would otherwise have been carried out on April 2nd. This closure emphasizes the importance of a longer holiday at Easter, viz., sixteen days, as recommended by the Medical Staff in the Report for 1916. In June Dr. Lilian E. Wilson, one of the Medical Officers of the Board of Education, met t-he Clerk of the Authority and the School Medical Officer at the Town Hall, and discussed details of the Annual Report, and the arrangements of the Dental Clinic and Minor Ailments Clinic. On November 17th it was found necessary to close the Infants' Department of St. John's School for sixteen days because of whooping cough. This was done with good effect early in the epidemic after consultation between the School Medical Officer and the Medical Officer of Health. The Statistics (Tables I., II., IV. and V.) were prepared from the Schedules and Cards by the School Nurse. The information for Table III. was obtained by her with the assistance of the Head Teachers, and the children were classified after examination by the Medical Inspectors. I wish to acknowledge the help given by the Teachers in the work of Medical Inspection and to thank them. Their co-operation is essential in order to obtain the best results for the children. The smooth working of the School Medical Service, especially that of the Cleansing Station, is due to the tact and valuable help of the School Nurse, Miss Linford Brown. The Clerk of the Authority and his assistant are thanked for the help readily given whenever required. W. ADAMS CLARK, M.D., April 29th, 1918. School Medical Officer.