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116
Annual Report of the London County Council, 1914.
the genera] improvement in all cases, indicates how necessary and beneficial is an institution of such a
kind, when available for the children of elementary schools. No haemoglobin tests were made, but marks
were carefully given at each examination for colour and nutrition, just as in the case of a general inspection
in elementary schools ; i.e., marks 1 to 5 for colour and marks 1 to 4 for nutiition.
The N. (nutrition) figure is very interesting, and, from observations here and in various playground
classes, seems to be very reliable as a comparative standard by the same observer, but it varies
with the personal factor where more than one observer is concerned. It is an index mostly of general
fitness in the athletic sense, of the elastic and firm condition of the flesh and body generally apart
from actual weight or actual amount of flesh. The weight in July may be only equal to that in the
preceding April, yet the N. figure may be raised from 3 to 1½, the condition of the flesh in the earlier
month being flabby and probably pale. This appears to be a usual occurrence in all these open-air
classes. The results yielded by the two series of terminal examinations shows that out of the 49 cases
where an alteration occurred, there was an average rise in N. of 19, and in colour of .16, or, roughly, a
rise of N. from 2.3 to 2.1, and of colour, from 2.4 to 2.2. The dates of individual records, however, vary,
averaging about the middle of June for the first observation, and about the middle of October for the
second. But it is satisfactory to note that about half the casss showed this solid improvement in nutrition
and colour.
Emulsion of cod liver oil is kept at the school, and supplied to suitable cases when they are not
receiving it from elsewhere.

Cases noted with defective chest expansion were given deep-breathing exercises by the nurse
The measure of the improvement obtained gives no actual guide to the total expansion of the lung, where
the amount of diaphragmatic expansion is not also noted, but improvement appeared to be general in all
cases.
The school doctor has been present at various meals and has found all arrangements as to cleanliness,
quality and quantity of food quite satisfactory. He has also seen the work of the school in every
detail that might have some bearing upon the general health. With the services of a nurse constantly
available, a high standard of cleanliness of hair, body and clothing has been satisfactorily maintained
even amongst children coming from the most unsatisfactory homes.
There has been very helpful co-operation between the nurse and teaching staff in all matters,
and every assistance has been given to the doctor by the head master of the schoool.
The average length of stay at the school, out of more than a hundred children on the roll at the
end of the year, was as follows:-18 had been in attendance for 1 term, 4 had been in attendance for 2
terms, 3 had been in attendance for 3 terms, 32 had been in attendance for 4 terms, the remainder in
attendance for more than 4 terms.
Playground classcs.
Since these classes were commenced in 1909 four different types have been tried. These types
have been—
(1) For specially selected weakly children in various standards:-
Type A.-Central classes for various schools and standards.
Type 15.—Single classes for one school and various standards.
(2) For unselected normal children of the same class in a school:-
Type C.—One standard spending all its time in the playground.
Type D.—The standards going to the playground in rotation.