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Report of the Medical Officer (Education).
91
The knowledge of school hygiene acquired is far ahead of practice, and with the exception of
the opening of the Tuberculosis School at Kensal House there is no distinctly new step to record.
Much, however, is slowly emerging, for with the demonstration, which is here practically completed, of
the minor part played by the school under present-day conditions in the dissemination of scarlatina and
diphtheria, and probably also of measles, the importance of the house becomes apparent. This also
is apparent in the conditions of adenoids, anaemia and debility, largely due to the want of playing
spaces, and to stuffy homes.
During the past decennium the London Education Authority has expended over £30,000 annually
for the education of children who have died from tubercle before attaining adult working life.
Small groups of children still remain for whom no Authority seems statutorily responsible.
The non-pauper imbecile, the morally uncontrollable, and the epileptic child are yet generally unprovided
for, although legislation is in prospect. Private schools occasionally seem hiding places in which
children are concealed from the protection which a public authority would exert over them.
A suggestion put forward some years ago that the statutory responsibility for all children
should rest with the Education Authority, involves a further consideration not yet mentioned. The
conditions of the public elementary schools are not wholly satisfactory from the health or social
point of view ; they will soon become good enough if every child in the country is compelled
to spend some five or six years of its life in attendance at a State school. The ultimate benefit of
such a requirement in the development of national solidarity and citizenship, and in the removal of
class distinctions need not be dwelt upon here, but the benefit in national health and improved schools,
and the desire for the betterment of education can scarcely be overstated. The opposition which such
a proposition, as a matter of practical politics, would be likely to receive on sanitary and educational
grounds is alone a proof of its necessity.
School hygiene has already passed beyond the school, in the wider outlook derived from study
of the children there. It has become a matter of public health and national interest. Room to live,
increased space for play, food and opportunities for cleanliness are the evident wants. Already public
health considerations suggest that a statutory limit should be assigned to the number of people who
may live 011 a certain area of land, and further that for each defined area buildings should only be
allowed to cover a small proportion of the surface.
These larger considerations will have to be ever in mind in all school health problems.
Medical inspection.
The administration of medical inspection is set out in the tables of analyses printed in
Appendixes II. to V. to this Report.
The full results of the medical inspection of children in London in 1911 gave over one-half of those
examined as presenting defects, of which about two-thirds were recommended for treatment. This
is neglecting dental defects, which are almost universal. As the diseases or defects are separately
classified, the defects and children are not strictly comparable, but the proportion who are doubly notified
is not large, so that the differences in the various age groups are scarcely significant.

In the general summary of medical administration in the Appendix, 54 per cent, of the children
had defects, and 38 per cent, had medical advice cards issued. Obviously the medical inspection now
carried on, on about one-third of the children annually is not sufficient in the extent of the children
examined, or else the results must be considerably discounted.
The majority of individuals if examined carefully enough, will be found to present variations
from normal which may be recorded as defects, but only in a minority of these cases is the defect material.
The fixing of standards is of extreme difficulty, and when first it was thought necessary to inform
parents that their children were in any way defective, the amount of defect was stated to be such that
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