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53
It was pointed out twelve months ago that the time was an hypercritical one and that weeping
philosophers flourished; in 1920 there were at first indications of improvement, and fanned by a
gentle breeze of optimism steady advance was made ; thus the Council's scheme under the Act of 1918
was approved and the task of putting it into operation undertaken. Then with the approach of
winter there came a frost, the effects of which were felt in the country generally; but London's
forwardness in the matter of preparation stood it in good stead, so far, inter alia, as school medical
work was concerned, and at the close of the year the "Council's Scheme" was still manifesting vitality.
In respect of physical conditions the great gains secured during 1920, are those accruing (a)
from medical oversight of continuation school young persons, and of children coming within the scope
of the new by-laws as to employment, (b) from the extended medical treatment scheme, affecting
elementary school children, secondary school children, and any "young persons" unable to obtain
treatment save under the Council's scheme, and (c) from the materially improved methods of cleansing
now being put into operation throughout London.
These gains are all substantial ones; from the purely medical and epidemiological aspects, (b)
is perhaps as great a gain as (a); and on the long view (c) an even greater gain than (b). The fixed
resolve to clear up the question of verminous infestation has only slowly grown into being, but the hope
may now be entertained that it is steadily gaining strength year by year and, once it really starts
upon its feet and goes forward, the delousing process should be as easy of accomplishment, when
determinedly undertaken in London, as has been found possible under military rule in Serbia or Poland.
This subject (c) is further considered on p. 78; and the extension of the medical treatment scheme
(6) on p. 67. It may be here noted, however, that a question of special and immediate interest arises
with regard to (a) continuation schools. These schools are now in being within London and in three
or four other education areas. Details as to medical supervision are given on p. 59; but an à priori
consideration, further referred to later, may here with advantage be cursorily mentioned.
This is the possible relation of blind alley employment to lowered phthisis mortality in adolescents.
The point has been raised by Dr. M. Greenwood (p. 70) in connection with an analysis of
the tuberculosis statistics of the 28 metropolitan boroughs. From these data the covariation of the
tuberculosis death rate with each of three other variables ("overcrowding," "other diseases" and
"factory employment") taken in isolation, has been evaluated. There emerge certain remarkable
contrasts between the correlation co-efficients for the two sexes at ages 25-45, of which more will be said
elsewhere; but the point specially deserving of note here is the negative partial correlation in the
group of young adolescents, between the index of overcrowding and the death rate from tuberculosis.
Dr. Greenwood reminds us that he is dealing with "partial correlations," which represent "residual
values" only; moreover, the index of overcrowding available is but "a rough measure of domestic
conditions"; still, he says, "it is a measure, and the arithmetical results lead to the paradox that the
worse the home conditions (so measured) the lower the death-rate from phthisis in adolescents."
This is not the first time correlation co-efficients, total or partial, have brought us up against a stone
wall of paradox. Dr. Greenwood tries to circumvent the difficulty by tentatively examining the
possibility that this, at first sight startling, negative correlation may not mean "that bad housing is
good for adolescents, but that it is correlated with something else which is good for them." And this
brings him to the question of blind alley employments. He says, "spending one's boyhood on the tail
of a van, driving a milkcart or carrying telegrams may be a very bad preparation for the economic
future; but it may be a good thing for one's health as a boy or girl." This hypothesis, by the irony
of fate, emerges from study of the statistics of an area in which blind alley employment has for many
years past been a by-word and in which continuation schools have this year been established. Dr.
Greenwood it should be remarked, is far from being satisfied with the suggestion made, indeed he
tells us that he is "alive to the insecureness of the argument "; but he says the question must not be
allowed to rest, "because if the explanation proved to be correct, it follows that the lengthening of
the period during which an adolescent is not of full earning capacity and the closing of blind alleys,
reforms which are about to become effective may, unless other suitable measures are taken, bring as a
by-product some increase of juvenile phthisis." Dr. Greenwood's investigation greatly stimulates
curiosity with regard to this and other topics considered in his paper, and in this report (loc. cit.) an
attempt is made to follow up the line of enquiry opened up for study. Here it must suffice to remark
that observations made in previous annual reports, concerning the behaviour of measles and scarlet
fever in schoolchildren in London, suggest a means of escape from the difficulty. Here, as in the
former cases, it seems possible that there may be discerned the effect of immunisation against later
attack, of children and young persons in the poorer boroughs, owing to their having already undergone
previous attack, in the case of tuberculosis by non-pulmonary forms of the disease.
During the year 208,924 children in the age groups were examined by the school doctors in
elementary schools, and of this number 82,740 were found to require treatment for one or more defects.
13,372 children at the age of 14 were examined prior to their admission to day continuation schools (see p. 8).
A further 1,923 children in the age groups were inspected in the special schools and 83,516 elementary
school children not in the age groups were specially examined, giving a total of 307,735. In addition
the school medical staff inspected 5,460 children for scholarship awards, and 16,315 children in
connection with their specific defect in special schools. A detailed analysis of the result of the
examination of elementary school children has been made by Dr. C. J. Thomas and is given on pp. 55-63.
The results of the examination of 12,408 students in secondary schools, trade schools and
training colleges are set out in the appendix Table IX.
The chief feature of the year has been the opening of a centre in Woolwich at which children
operated upon for enlarged tonsils and adenoids are kept for two days after the operation. The
Medical
inspection
Secondary
Schools, etc.
Medical
treatment