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2.—The disease is usually contracted abroad. Before any foreign-born child is admitted to a
school in this country the head of the family should produce a family bill of health, which should be
countersigned by the school doctor.
3.—If contracted in this country trachoma is not spread during attendance at primary London
schools, but in dirty homes by carelessness.
Trachoma is uncommon, even in such "favourable" schools as those in the Ghetto area, and it
occurs unevenly in that area, apparently varying according to the proportion of the population of
foreign extraction, and especially incident in those areas which contain most foreign-born.
Overcrowding, in spite of by-laws and regulations, is still rife, and menaces public health.
HEARING.
The examination of the hearing of young children presents great difficulties from the
psychological aspect, the child failing to react when often it hears quite well. No testing of this
sense has been made on any sufficient scale among London school children.
It was estimated in my first Report to the late School Board that probably deafness alone
interferes to a considerable extent with the educational progress of at least 5 per cent., and to some
extent with at least 10 per cent. more.
The catarrhal conditions common in children and associated with debilitated conditions, want
of exercise, deficient development of respiratory capacity, and backwardness in school should be
well known to every teacher.
The presence of "adenoids" is exceedingly common in the damp climate of London. The
child with open mouth, frequently nasal discharges, and generally unintelligent appearance is often
wonderfully altered by operative treatment. Cases have been deemed mentally defective or so
deaf as to require special education by lip reading, but have in a few weeks after operation been
able to return to the ordinary school. Operation is indicated wherever a child is a mouth-breather
and snores at night.
We have some reason to think that such children, apart from the condition of debility which is
present unfitting them for education, are also more liable to contract scarlatina or diphtheria. They
also suffer liability to suppurative diseases of the ears to about five or six times the extent which
children breathing normally do. The importance of such treatment may be strangely overlooked.
It is generally passed unnoticed in the children who visit ophthalmic hospitals; and a child has
been seen who had spent nine months of the last three or four years in a general hospital, but has
been a mouth-breather probably all the time, and within the last three months has lost the hearing
through double otitis, the sequela of neglected adenoids.
The teachers who notice the symptoms of mouth breathing and snoring, and persuade parents
to seek relief for their children, are not only assisting the children to become better pupils, but are
conferring a lifelong benefit on them. In this matter, too, the influence of the intelligent and
conscientious teacher is very evident.
SPECIAL SCHOOLS.
Examinations.—Between 1 and 2 per cent. of the children are so defective in some respect
that they may be classed as unfit to properly benefit by instruction in the ordinary school.
When such a child becomes known, the head teacher, or divisional superintendent if the child
is not in school, gives particulars of the case on a form provided for the purpose. This form is
then forwarded to the Medical Officer, and medical examinations are arranged at various centres,
at each of which not more than twenty cases are presented. The Medical Officer makes a report
on each case so examined, and the children are educated in accordance with this report.
During the past year the number of examinations required has very considerably increased.
Altogether 339 examinations were held, and 5,048 children presented, with the following
results:—