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52
REPORT OF THE SCHOOL MEDICAL OFFICER (Dr. W. H. HAMER) FOR THE YEAR 1920.
PART IT. (EDUCATION).
Introductory Note.
In a New Year's address entitled "Continuity in Change" there appeared in the Literary
Supplement of the Times, the statement that " At this New Year (1921) the whole world seems to have
reached a great moment of transition. It seems to have got near the top of the narrow pass which
will look over into a new era. Some climb with high hope confident that the unseen country on the
other side of the mountains will prove to be a land flowing with milk and honey. Others accustomed
to the sights and sounds of the valley in which they have always lived, and to its familiar way of life,
shrink from the crossing over." So far as school medical work is concerned the results obtained
during 1920 justify confidence for they have been favourable beyond all expectation. To begin
with, in London, the general death rate and the infant mortality per 1,000 births are lower than they
have ever been before, and the recently available reinspection results, obtained by the school doctors,
show that here, too, a record level was obtained in regard to the percentage of school children found
defective who had been treated during the year, or who were at the end of the year still under treatment
(see p. 62).
In commenting four years ago upon the marked decline in infant mortality, "which actually
dates from 1900, and potentially of course, from long before that year" (Ann. Rep. 1916, p. 5), it was
pointed out that the influence of schools for mothers and infant welfare centres was then only just
beginning to be felt and that it was to be hoped that this influence would steadily grow, " but that
it should be recognised that so far as schools can be said to have had any effect in producing the decline
of infant mortality of the last 16 or 17 (now 20 or 21) years, it is the schools established under the
Education Act of 1870, and not the schools for mothers which date from 3 or 4 (now 7 or 8) years ago,
that are in question." It was noted that just as the boys had, according to high military authority,
made good soldiers, "in spite of the Board Schools," so it might apparently be assumed the girls had
made better mothers "in spite of their having enjoyed the advantages of an elementary education."
It seems reasonable to conclude in fact that the main cause of the improved health of the children during
the last 30 years has been the advance in public health generally, materially aided and supplemented,
however, by the increased realisation by the modern parent of a sense of personal responsibility.
Confirmation of this view is to be found in the notable decline of the general death rate since
1870, and in infant mortality since 1900; the delayed response of the latter death rate may be
attributed partly to the fact that, speaking generally, the enhanced force of parental influence followed
only after an interval upon that exercised by health authorities. The latter, moreover, had some
years start of the education authorities, and it was not until the Education Act of 1870 had been
operative for a generation that its full indirect effect exerted through the parents upon the youngest
children could become clearly manifest. Furthermore, improvement as regards infant mortality,
though anxiously looked for in "the nineties," was masked in large measure by exceptional epidemic
manifestations (diphtheria, scarlet fever, influenza, diarrhoea) in those years; but the fall at length
unmistakably commenced with the new century, steady improvement followed from 1900 to 1914,
and the position gained was practically maintained during the years of war, while during the last two
years still further advance is recorded. Thus it would seem that a new factor has begun in the last
10 or 12 years, to assert itself, and the direct work done in the schools, and for children under school
age in the maternity and welfare centres, seems to be now finding manifest expression.
A great deal of this work, it must be remembered, has been voluntary work, carried out just for
the work's sake, and the fact that so much has been accomplished is clear proof of the ever widening
interest taken in child welfare. Indeed, accompanying the limitation of the amount of danger, to be
apprehended from disease producing infective agencies, there has been notable manifestation of the
"infectiousness of good things," resulting in a fostering of the interest, taken by many thousands of
workers, in the promotion of the healthiness of the bodies as well as of the minds of the rising generation.
The attempt to measure the good results accruing from all these efforts in terms that can be
appreciated by mere lookers-on is hedged about with difficulty. The school doctor must perforce fall
back upon school records, and the tests mentioned last year may be again appealed to. Dirt, overcrowding
and hunger are the three main physical evils which, it has been said, have affected humankind
from the time of the cavemen onward. Applying these tests there was marked improvement so far
as London children were concerned, even during the difficult years of war and the first succeeding year
of peace. The year 1920, too, has not been without its difficulties. Someone is reported to have
said in the early years of the war that the seventh year might be expected to be the most difficult; this
prophecy as applied to the war happily failed, but a pessimist of to-day suggests that it might prove
true if applied to the years of peace. So far as London is concerned, however, the year 1920 showed
distinct further improvement as regards the first test and a new departure (see p. 78) in the special
campaign against vermin was inaugurated; as to overcrowding some progress is undoubtedly being
made, but the effect of this upon the statistics could not as yet in the nature of things be apparent:
referring to hunger, the conditions of 1920 have been favourable, the number of necessitous children fed
having been less that a quarter of that of the pre-war period, but in the closing months of the year
there was an upward tendency, inasmuch as there has been some slight falling off in the "nutrition"
of entrant infants (see p. 56) and forebodings have not been wanting as to the possibilities of 1921
in this regard.