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in municipal creches (where such establishments exist) to girls by making this branch of teaching
eligible for aid from the grant for public education; the need for strengthening the inspection and
supervision of workers in factories and workshops: the need of "bringing home to men and women
the fatal effects of alcohol on physical efficiency"; the desirability of requiring in tenement houses
that proper provision should be made of the cooking apparatus necessary for the preparation of food;
the need of strengthening existing powers for control of milk supplies, etc. These questions have from
time to time been before the Council and its Committees, and the policy followed with regard to them
has, generally speaking, been entirely in accord with the recommendations of the Inter-Departmental
Committee.
The Medical Supervision^of School Children.
The year 1904 will always be notable in the sanitary history of the Metropolis for the reason that
by the transfer of the administration of the Education Acts to the London County Council, a health
authority is brought into direct relation with a large proportion of the child population of London. This
change in administration gives opportunity for the study by a health authority of the conditions which affect
the growth and development of the young, and for the application of measures which tend to promote
improvement in their physical condition. It gives greater opportunity, moreover, for the study of the
behaviour of communicable maladies which affect the whole population, but which have their greatest
incidence upon children, and for the application of knowledge thus obtained to the limitation of risks
which are inseparable from the aggregation of young and susceptible persons, and which have in the
past been productive of regrettable results upon the prevalence of disease, not only among school children
but among the population at ages other than those of school life.
There is, therefore, much reason for anticipating that as the outcome of the change referred to, a
higher standard of health will eventually be attained, and that this benefit will be shared by the London
population as a whole. The London County Council has recognised the intimate relation existing
between its medical supervision of school children and its health duties in respect of the
population as a whole, and for administrative purposes has associated these two branches of its work.
The annual report of Dr. Kerr, the medical officer specially appointed for the supervision of
children in its schools, is appended to this report (see Appendix III.).
As already stated (page 84), the Inter-departmental Committee on Physical Deterioration
recommended the institution of an anthropological survey of the population, especially of children,
and Dr. Kerr is able to present figures showing weights and heights of a limited number of children at
several ages, and to discuss the effect of home conditions upon the physical development of children,
and also the relation between this development and the infant mortality rate of the year in which they
were born. Obviously, more complete data are necessary for drawing reliable inferences and it is much
to be hoped that these will eventually be forthcoming.
Dr. Kerr gives account of the steps taken to ensure the cleanliness of children attending school.
The action which is thus being taken will do much to improve the condition of that part of the population
which is subject to verminous infection. The cleansing of the people in this respect would be
more successfully attained if sanitary authorities would adequately exercise the powers conferred upon
them by the Act of 1897. There would further be advantage in educating children in the habit of
bathing. Mention was made in the annual report for the year 1897 of the provision of baths made in
the public schools of some continental cities and in which children periodically bathed.
With reference to the prevalence of infectious disease among school children, Dr. Kerr's report
shows the steps taken during the year for limiting the spread of such disease, and he discusses the part
played by unrecognised or "carrier cases" in the dissemination of diphtheria. In this connection reference
may be made to the method adopted by the Medical Officers of Health of Bermondsey and Finsbury
for dealing with such cases occurring in houses invaded by this disease (see page 31 ante). It is obviously
important that as complete steps as possible should be taken to exclude from attendance at school,
children who are harbouring the bacillus of diphtheria in their throats, though not suffering from any
clinical symptom of disease. There is much reason for thinking that systematic enquiry for such cases
in connection with recognised cases of diphtheria and their exclusion from association with schoolattending
children would limit the extension of the disease. In judging of any results obtained at the
present time it must be borne in mind that diphtheria is now declining in London.
Appended to Dr. Kerr's report is a report by Dr. Thomas, who is working with Dr. Da-vies, the
Medical Officer of Health of Woolwich, in an attempt to determine experimentally the amount of value
which attaches to school closing in arresting the spread of mearles. The extent to which children
at the several ages are found to have been protected by previous attack is of much interest.
There is reason for hoping that parents who now disregard the occurrence of measles in
their families will later strive to extend to their own children and to those oi their neighbours
a protection which would at least tend to postponement of the age of attack when the fatality
is lower. The Order made by the Council, extending to measles certain provisions of the
Public Health (London) Act, which came into operation in 1903 appears to be already having some
influence in impressing the public with the dangers attending exposure of young children to measles
contagion (see pages 24 and 25). Dr. Thomas, moreover, points out the value of sanitary buildings
and training of teachers for arresting the spread of measles, in both of which improvement may be expected
in the future; but there is no doubt need for those who have control over children gathered together
on Sunday to be imbued with the same spirit as those in charge of week-day schools.
While noting that recent legislative changes have increased the probability of better control of
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