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58
Ear disease
and deafness
Closely associated with the prevalence of enlarged tonsils and adenoid growths are discharging
ears and hardness of hearing. In these conditions, too, there is no difference between the incidence
upon boys and girls, but while that of ear disease, which is curable, diminishes during school life, being
highest amongst entrant infants, the effects of ear disease, hardness of hearing, being often permanent
accumulate during school life and deafness is found more often amongst the oldest scholars than amongst
the youngest. Two per cent. of the children in the age-groups were found to be suffering from ear
disease and 0.9 per cent. from hardness of hearing, both figures being fractionally less than those of last
year (2.2 per cent. and 1.0 per cent. respectively). An analysis of the cases of ear disease shows that over
80 per cent. are suffering from otitis media and otorrhoea.
Visual acuity

The table of visual acuity given above shows continuing improvement. Not only is the number
of boys and girls who possess normal vision increasing each year, but a very satisfactory improvement
is noted in 1920 over all previous years and the disparity between the vision of boys and girls at the
older age continues to diminish, although it still exists. The sight.saving campaign in the schools
is, therefore, bearing fruit. In this connection it should be pointed out that ophthalmic surgeons at the
hospitals and treatment centres now very frequently forward recommendations with regard to modification
in the studies of children with weak eyes at school, and that these recommendations for "oral
teaching only" and "easy treatment" are being adopted largely by the teachers in these special
cases. Formerly it was constantly noted that the proportion of children at the older age with bad
vision was greatly in excess of that at the earlier age and this was taken as a condemnation of the
methods pursued in the schools; in 1920, for the first time since medical inspection was introduced,
the proportion of children at twelve years of age with serious defect of vision uncorrected is less than that
of the children at eight years of age. This is a very notable achievement and shows that the measures
taken by the Council are conceived on right lines.
Squint
2,564 cases of squint were noted at routine inspections, rather more than one per cent, of the
whole number examined.
Heart
defects and
anaemia
7,086 children in the age-groups were returned as suffering from heart defects (or 3.4 per cent.),
which is identical with the proportion found in the previous year, and 8,566 (or 4.1 per cent.) with anaemia,
an increase of 0.6 per cent. The preponderance of the incidence of heart defect upon the older girls is
still very marked. Older boys suffer less than any other group from anaemia, presumably because they
spend more time in the open air than the others. In 12 per cent. of the cases of heart defect organic
disease is definitely diagnosed.
Lung
complaints
9,845 children were recorded as presenting some lung trouble ; this represents 4'8 per cent., which
is practically identical with the proportion found last year. There is little difference in the incidence
upon the sexes, but there is a great disparity in the age incidence. Infants provide by far the greatest
number of sufferers from bronchial catarrh and this condition is no doubt associated with the prevalence
of rickets in younger children.
Phthisis and
other
tuberculous
diseases
460 cases of phthisis (0.2 per cent.) were recorded at routine inspections and 543 cases (0.3 per cent.)
of other tuberculous lesions. The proportion of other tuberculous lesions was the same as in 1919,
but the proportion of cases of phthisis showed a fractional decline. Not more than one in five
hundred children attending regularly at school are therefore found to have phthisis and of these more
than half are already known at the date of inspection and are under observation. These, of course,
are not " open " cases or they would not be in attendance.
Rickets and
other
deformities
Rickety manifestations were noted in 2,815 children (13 per cent.) compared with 17 per
cent. in 1919. The chief incidence is upon infants, of course, and more largely upon infant boys than
infant girls.
3,342 cases of deformity other than rickets were found (1.6 per cent.), a proportion identical with
that found in 1919. Again, the preponderance of incidence upon the older girls is marked, consisting
practically entirely of minor degrees of spinal curvature.
Diseases of
the skin and
external eye
disease
3,860 children were found suffering from skin diseases (1.8 per cent. compared with 1.9 per cent.
in 1919), and 6,705 with external eye disease (3.2 per cent. identical in proportion with that of the
previous year). These diseases are largely due to dirt and unhygienic home surroundings. The undue
prevalence of scabies of late years has been referred to, and in a later section of the report it will be
shown that the prevalence of scabies still remains serious. About one quarter of the cases of skin
disease were found to consist of scabies and another quarter of impetigo.
Albuminuria
It is impossible to examine the urine of children in elementary schools as a routine practice, nor
in the light of what is known of the occurrences of albuminuria in children does it appear desirable