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Arrangements are made whereby an analysis can be carried out in particular cases. Dr. Frewen Moore
asked permission to carry out an investigation in December, 1920, on boys in a London elementary school.
397 boys were in attendance and in every case a specimen of urine was obtained and tested by the
salicyl sulphonic acid method. 91 boys were found who had albuminuria in varying degrees, i.e., no
less than 23½ per cent. Similar high percentages have been found by other investigators. Bugge, in
1913, found albuminuria present in the urine of 14.9 per cent. of boys and girls in the elementary
schools of Christiania. Clement Dukes, in 1907, noted albuminuria in 16.4 per cent. of the entrants at
Rugby. Nicholson, in 1914, found 28 per cent. of the boys in Framlingham College had albuminuria.
Practically all these cases of albuminuria must be looked upon as physiological, but from investigations
made by Dr. Boome at the elementary school above mentioned, it would appear that the better boys
are "trained" for sports the less likely they are to have albuminuria. This raises the interesting question,
which has not previously been taken into consideration in such investigations, whether physiological
albuminuria is not associated with the presence in the blood of fatigue products. Reviewing the
literature of the subject in the light of this idea there appears to be much to be said for this view, as
many investigators find the number of individuals presenting albuminuria increases with strenuous
exertion of a sporadic nature.
It is but rarely that children suffering from congenital syphilis are found in elementary schools.
The action of the syphilitic virus upon the progeny of those suffering from the disease is of the "all
or nothing" type. Usually what is found is a series of miscarriages which may be followed by the
birth of normal children, but intermediately a child may be born showing signs of congenital syphilis.
Generally such children, if they survive, develop serious defect and are to be found in special schools
for the mentally defective, for the blind, or for the deaf.
Not so many as one hundred children in ordinary elementary schools out of 200,000 examined
are found with the least trace of congenital syphilis. In one year when the reports were carefully
scrutinised, out of 224,264 children examined, including both routine and special cases, there were only
58 cases where Hutchinsonian teeth were noted, 13 cases of interstitial keratitis and 15 cases where other
signs were present of congenital specific disease. These figures include doubtful cases. It is clear
therefore that the percentage of children attending elementary schools in whom some taint of congenital
syphilis can be found by the ordinary methods of medical inspection is very small.
Hitherto the last age-group inspected has been that of twelve-year old children. There has
therefore been two years left of school life during which ameliorative efforts have been effective, but the
complete results of those efforts have, in the absence of a final inspection, not been fully recorded.
During the Autumn term of 1920, 6,956 boys and 6,416 girls at the age of 14 were inspected in detail
as entrants to continuation school. Thus we have for the first time material from which to judge the
final result of care during elementary school life. The records of the inspection of these children fully
confirm the deductions made from the results of the three earlier age-group examinations and show
that those tendencies already described are continued and confirmed. The nutrition of these fourteen
year old children was found to be distinctly better than in the twelve year old children, only 4.7 per cent.
of boys and 4.4 per cent. of girls being recorded as under-nourished, compared with 6.3 per cent. and 5.6
per cent. respectively at age 12. The fourteen year old girls were appreciably superior in personal hygiene,
fewer being found with nits in the hair. The condition of the teeth was slightly better than that of
the twelve year old children as was the acuity of vision, although the boys still preserved their superiority
over girls in this latter respect. There is a continued fall, in the proportion of children with
unhealthy conditions of the throat, in " dirt" diseases of the skin and eyes, in anaemia and in lung
defects. The preponderance of girls with heart defects and deformities is still marked over boys,
but there appears to be no very significant increase in the numbers so affected.
In short it may be stated that the last two years of school life are good years so far as health is
concerned ; no new disturbing factor is apparent at work, and all the effects of amelioration noted
through the earlier years are continued to the end. Particularly gratifying is the improvement in
vision, as the proportion of children with more serious uncorrected defect continues to fall.
As might be expected the children in the special schools show a much higher degree of defect.
than those in the ordinary schools, even in the case of conditions which have no relation to their special,
defect. They are far worse clad; they are very much less well nourished (13.9 per cent. undernourished
as against 6.6 per cent.); their cleanliness is far inferior. The acuity of vision is very much
lower than that of the normal children, defects of hearing, ear diseases and defects of speech are increased
by the hundredfold. There is in fact no ill to which the flesh is heir in which an excess is not shown
by the children in the special schools over those in the ordinary elementary schools. It would appear that
the degeneration which produces the special defect which prevents them from profiting by instruction
in the ordinary school is part of a general degeneration involving all tissues and organs alike, although
it must always be borne in mind that for a variety of reasons remedial measures are harder to carry
out in the case of defective children than in the case of normal children.
The inspection of special cases is a most valuable section of the work, and the numbers seen
approximate to those of an age group. The bulk of the cases of skin disease coming under notice is
derived from this group and greater numbers of cases of conjunctivitis, of epilepsy and of chorea
were found amongst the 56,571 children brought forward for examination because they appeared
to be ailing than were found amongst the 222,296 children in the age groups. All the above conditions
are such as cannot fail to strike the attention of lay observers. On the other hand the bulk of those
conditions that can only be revealed by skilled clinical examination continues naturally to be found
only at set inspections, and without routine medical inspections of all children nearly all the cases of
defective vision, of enlarged tonsils and of chest complaints, including serious defect of heart and lung,
Congenital
syphilis
I
Children at
14 years of
agd leaving
for continuation
schools
The routine
inspection of
special
school
children
Special casts
61001
I 2