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Report of the Medical Officer (Education).
127
(b) 123 schools, examined on an "intermediate" scheme. Entrants, leavers and the
8-9 age group. The infants here did not have cards filled up unless there was urgent need for
treatment, they were "cursorily inspected."
(c) 130 schools, examined in accordance with the scheme to be maintained during the
present Code year (1910-11). The entrants, leavers and 8-9 group are all examined and have
cards made out, but hitherto in the case of entrants only those examined in detail have the
cards fully filled in.
In the last two schemes in addition "urgent cases" at any age, presented by the teachers were
examined. The figures are given in Appendix III.
After this Code year it is proposed to examine in detail all the entrants, and fill up cards
for both healthy and ailing children. The comparison of the work done under the three
categories is shown in Appendix IV.
As already stated these different groups vary in result according to the numbers of infants.Of
the children examined in full detail there were recorded in last year's report (1909) the results of
37,420 examinations, with 12,656 or 33 per cent. requiring medical treatment. These represented
chiefly children at all ages. In 1910 of the 172,619 children examined and noted in detail 52,954 or
32.6 per cent. had advice cards given. The proportion of children who will be selected by the
doctors after careful examination and given advice cards can now be fixed on the basis of the last two
years as 65,610 out of 210,039, that is 32 per cent. or approximately one third of those examined.
Of the 172,619 children recorded, 81,151 were returned as normal, that is free from
any definite organic defect. Bad defects of vision or eye diseases were recorded in 18,923. Defects of
throat or nose were 29,927 ; of ears or hearing, 9,499 ; skin disease, 2,913, this includes 453 ringworm
cases found by the doctors, ringworm cases being generally excluded by the nurses. Other diseases were
recorded in 15,296. It will be seen that these are minimal numbers, and in the case of visual
defects a comparatively low standard is taken, below Standard V. for instance, visual acuity of 6/18 is
taken as the beginning of what is called defect. The returns of each day's work are made on
Form M.O. 190, a copy of which is given in Appendix V.
A summary of the work done in reporting on school buildings is given in Appendix VI.
Considerable importance attaches to the estimate of the state of nutrition of the individual
children. This is usually done by ocular inspection, the general appearance of the child, his person
and carriage, expression, signs of activity or listlessness, colour of the face and of the lips, roughness
or otherwise of the skin, being all taken into consideration. In addition by palpation the observer
notes the firmness of the tissues and the extent of subcutaneous fat. The estimate has been recorded
in numbers from 1 to 5 following the scheme used by Dr. Thomas (see Annual Report, for 1908,
p. 17), the limit of the groups being defined as—
1. The "pink of condition."
2. Very good muscular development with only fair general nutrition as indicated by
subcutaneous fat, etc., or vice versa.
3. Fair all-round development.
4. Very poor muscular development with a fair amount of subcutaneous fat or moderate
muscularity and little or no fat.
5. Very poor muscular development with little or no subcutaneous fat.
At a later stage the classification was reduced to a threefold table of good, moderate and bad; good
comprising 1 and 2 of the foregoing and bad 4 and 5. This reduced the number of border zones in
which there was room for personal equation ; the observer tending to set a standard by the children
in the group actually under observation rather than from the whole in all types of schools. This
equation affected results when a good tvpe school was substituted for a poorer one and vice versa.
School
Buildings.
Nutrition.

Some check or further method of estimation is desirable, but difficult to obtain. In adults the
ratio of stature to weight is in general use and receives general acceptation and, since one factor, the
stature, may be taken as stationary, the weight in the main varies with the nutrition. This is the
more useful in cases where the weight is deficient. None the less, as spare and obese types exist, a
wide variation must be allowed for within the limits of health. Apart from the influence of illness
the weight varies with such conditions as food, sleep, general hygiene, character of occupation, temperament
and race. In children the estimate must be of an even more complex nature since both stature
and weight vary and not necessarily together, the increment at one time favouring the one more
than the other. It is generally believed, following the investigations of Schmidt Monnard and Mailing
Hansen, that the growth in stature is greatest in the spring and summer, when the weight is comparatively
stationary while the chief weight increment occurs during the autumn months. This would
seem largely confirmed by the observations made at open air schools. If the grams weight per centimetre
of stature be used as an index it would be necessary to use a somewhat higher index as the
normal in winter than in summer.