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The condition of the teeth was noted as similar to other elementary schools. The cleanliness
and sufficiency of the clothing were expressed as one quality representing social condition—about a
quarter were very good, a half average, and the remaining quarter only fair as regards clothing. Only
5 per cent, were bad in this respect. Nearly all the clothing is second hand or more remote still. It would
be an advantage if pawnbrokers were compelled to disinfect all clothing to be sold secondhand.
This last enquiry was conducted in the autumn when many of the children had just returned
from "hopping" and probably were in better condition than at any other time of the year.
In a paper recently published, Dr. Gastpar,* the Medical Officer of Schools in Stuttgart, shows
that among some 8,000 Würtemburg children examined in the last four years, the difficulties of classification
for statistical purposes according to nutrition were so great that he abandoned individual
classification for classification in groups.

* Zeits f. Schulgesundheitspflege 1908. 11.
These figures, perhaps, give excessive percentages of defect judged by' our English standards
but they express in figures the enormous importance as a national duty of bringing up every case of
poor nutrition to at least the average standard and this is sufficient excuse for their introduction.
It was noted both by Dr. Squire and Dr. Sikes that children are often sleepy and scarcely fit
for school work after a full meal. Dr. Guest notes this as occurring for a few weeks and being succeeded
by improved tone. It is probable that it is more marked the more debilitated the child is, and must
be taken as an indication of the child having been in a condition in which schooling was being wasted
and feeding required. From these observations at Sirdar-road and Laxon-street as well as the previous
wider enquiry, it seems that there will always be a certain number of children who require more food
than they get at home but that provision of school meals, although important and even necessary,
is only a small part of what is required towards completely combating ill-nutrition prevalent among
children attending school, and a similar opinion is held by all the members of the medical staff who
have made special enquiries on this matter.
SCHOOL EXCURSIONS.
A few vacation schools are held each year with good results to the children of some of the
poorest districts. There has, however, been opened up to education authorities through the recognition
by the Board of Education as school attendance under article 44 of the Elementary Schools
Code of school journeyings involving residence outside the county, opportunities for practical education
by bringing town children into direct contact with fuller and fresher experiences of nature than most
of them have the chance of enjoying. One or two headmasters have made such journeys very great
educational events in their pupils' lives and from the view of health and physique there is everything
to commend this new extension of school work. Arrangements should be made for all children going
on such expeditions to be seen by the school doctor at least two months previously. In the case
of the excursion to the Isle of Wight 51 boys were examined previously by Dr. Eiviere, two being
excluded on account of well marked mitral disease of the heart. In addition 7 boys showed some cardiac
dilatation. This was slight except in one case (A) a boy of a nervous, restless type, whose heart was
considerably dilated (dulness 1 inch to right of sternum and outside left nipple line). He was advised
not to go, but on his own doctor's permission, he was sent with restrictions. Another boy (B) appeared
to have some chronic kidney trouble with hypertrophy in addition to dilatation. A third (C) showed
some incoordination of movement suggesting the early onset of chorea, his heart was of poor tone,
but hardly dilated, he was sent with restrictions. The others had just sufficient dilatation to be noteworthy.
Two days after the boys returned from their journey great improvement in health appeared
in all who had been previously noted as sound, and no cardiac dilatation appeared in any. Of the 7
noted with dilatation previously 3 showed a distinct increase. Their general health was either worse
or not improved. The average sound boys then got much benefit from their expedition and
no heart dilation resulted, whereas of the seven boys with weak and somewhat overdone hearts, three
were distinctly worse, one was not improved, and one was probably saved by having been restricted,
the only two who were not worse were boys who had been very anaemic. It is evident that with boys
of these ages prolonged exercise must be avoided if they show any signs of being fagged, and that a
considerable period of rest must be allowed in each period of twelve hours.