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It may here be noted that Sir Shirley Murphy, as long ago as 1898, called attention to a question
of importance with regard to comparative death rates at certain age periods, in groups of London
sanitary districts arranged with respect to their condition as to overcrowding. (See Ann. Rep. M.O.H.,
County of London, 1898, Diagram xix. opposite p. 46.) The point raised is really very much the
same as that disclosed by Dr. Greenwood's partial correlation co-efficients—for, as reference to Sir
Shirley's diagram shows, at age 5-20 all save the two extreme groups of boroughs with most overcrowding
stand in a better position qua phthisis than does the group with least crowding. Dr. Brownlee,
moreover (Medical Research Committee's Report on Epidemiology of Phthisis, Part III., pp. 50-54), has
surmised "that in some way tuberculosis in childhood protects against tuberculosis in early adult life,"
and again "that some degree of immunity may be developed during childhood which persists into the early
adult ages." Dr. Brownlee has worked out in this connection the correlations between percentages of
infected milk and the amounts of his so-called "young adult" and "middle age" types of phthisis—
these are—76 and + .50 respectively. The bearing of such results upon some of the questions
at issue was considered in my annual report for 1919, p. 22.
It seems at least clear that immunity, however brought about, may supply a partial explanation
of the apparent paradox that young adults (15-25) in the poorer boroughs are less liable to pulmonary
phthisis than persons of like age in less poor boroughs; just as, in the same way, the schools in the
poorer boroughs yield less scarlet fever, and the infants departments in the poorer boroughs less
measles, than the corresponding schools and departments of other boroughs. Here, it seems, is a
tertium quid the credentials of which are deserving of examination; one which may throw light on
the correlation between overcrowding (measured by more than two to a room) and comparatively low
phthisis death rates in adolescents; one, moreover, which will obviate the need either for further
defence of the policy of closing blind alleys, or for entering upon a studied justification of continuation
schools.
Nursery Schools.
There are in London nine recognised nursery schools accommodating 330 children. Of these
two are attached to the Goldsmith and the Gypsy Hill Training Colleges, and one, the Rachel
McMillan Nursery School in Deptford, is recognised as a training centre for nursery school teachers.
The Nursery School at Christ Church L.C.C. School, Hampstead, is the only school for which the
Council is entirely responsible.
In all these schools provision has been made for frequent medical inspections of the children
in attendance, and arrangements are in force in all cases for treatment of major and minor defects. For
the most part treatment is obtained at the ordinary school treatment centres.
Six schools are visited daily by one of the Council's nurses, whose duty it is to inspect the children,
paying special attention to children who have been absent. Children returning to school after sore
throat or infectious disease are kept apart from the other children until after the nurse's visit. In this
way the possibility of infectious disease being introduced into the school is considerably reduced. The
nurse also deals with minor ailments, and is responsible for the cleanliness of the children. The standard
of cleanliness in these schools is exceptionally high.
Open-Air Education.
Definite progress has been made during the year in the provision for open-air education. A
residential convalescent camp school for 64 girls has been opened at Wanstead House, Margate, an
additional open-air day school for 200 ailing children has been established at Stowey House, Clapham
Common, 94 open air classes in playgrounds and parks were held as against 87 in 1919, and children
were examined in connection with 283 school journeys as against 124 in the previous year.
The provision of these extra facilities represents a notable step in resuming the progress which
was arrested during the war, but it is to be feared that straitened financial circumstances will now
intervene and restrict the normal growth of facilities, however desirable they are.
This establishment was placed by the King at the disposal of the Council in the summer of
1919; it was actually opened for the reception of the first draft of boys on August 8th, 1919. The
total number of boys admitted during the year 1920, was 2,700. The admissions to the school are
drawn from the ranks of those boys, who by reason of existing anaemia, debilitated conditions or
malnutrition, appear likely to benefit by a stay in the country. No child under the age of ten is
admitted; actively tuberculous cases, mentally defective boys, and those suffering from persistent
enuresis are ineligible. Enuresis did occur at the school, although the greatest care was taken to
exclude such cases. In several there had been a history of it some time previously, but apparently
they relapsed under the different conditions prevailing at the school. Although since the opening of
the school (September, 1919), 3,500 boys have passed through it, there have been only two cases of
diphtheria, two cases of scarlatina and one case of measles. Much attention during the year has been given
to the question of vermin amongst the children. The boys for admission are inspected at various
centres on Monday of each week and sent down to the school (if apparently clean) on the following
Tuesday. Boys who are found on the Monday to have nits are re-examined by the nurse at the school
on the Tuesday before starting for Bushy, and if still found to have nits are not allowed to proceed.
Children definitely verminous are rejected.
The children are examined as carefully as is possible on these occasions, but it is impracticable
without a strong lens to detect nits in the scalp or to find body vermin in the seams of the clothing.
As an instance of the difficulty in detecting nits with the naked eye, an experiment was made at Addison
Gardens School on a batch of these candidates for the Camp School. The boys were carefully inspected
both by the doctor and the nurse, and those considered clean (twenty in number) were again seen by a
The King's
Canadian
Camp School
Bushy Park.