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Report of the Medical Officer (Education).
135
of true flat feet had been reached. The distribution in age and sex is shown in the following
diagram:—
His conclusions are—
1. That children of either sex are equally affected.
2. That the condition becomes more marked during periods of sudden increase in stature
and weight.
3. That where malnutrition is general a high percentage of deformity may be expected.
4. That where the surroundings are unfavourable a slight and curable degree of deformity
tends to pass into a condition which is permanent.
The effects of malnutrition are intensified by mechanical causes as excessive standing, walking
or weight carrying and by the wearing of heavy rigid improperly shaped boots. Children under eight
years of age can be found wearing boots which weigh from 2 to 2¼ lbs. Many of the boots worn by
school children are made regardless of anatomical considerations so that the foot is forced to conform
to the shape of the boot. The manufacturer of cheap boots appears to appeal to the vanity of the
parents by reproducing fashionable shapes at a low price. Soft leather will in time conform to the
shape of the foot, but if the pliant growing foot of a child is forced into a boot similar in shape,
but made of unyielding leather and rendered unbendable by the nails and rivets used in the process
of manufacture, the foot is cramped in the direction of least resistance and the end is deformity. The
great toes of many children before the age of 14 are found to be already forced outwards from the middle
line as a result of wearing improperly shaped boots ; practically all these children are flat footed.
Another important point is that these boots extend up the leg so that when laced the foot is
nearly immovable at the ankle joint. In ordinary walking the child either shuffles along the street
or, with an exaggerated movement at the knee joint, lifts the foot off the ground and carries it forward
without any flexion at the ankle joint. When attempts are made to walk on the toes, as in dancing
or drilling, the arch of the foot is forced downwards. Although the syllabus of physical exercises
issued by the Board of Education warns teachers that such exercises as heel raising or jumping cannot
be properly performed in badly fitting or unsuitable foot gear the caution is not always regarded, and
it is a pathetic sight to see children with their toes crowded together in heavy rigid boots endeavouring
to maintain their equilibrium. The results are likely to produce an opposite effect to that desired.
Dancing is taught to give grace and ease of movement; freedom of action of the joints of the feet is
necessary. With the children wearing heavy badly shaped boots the lesson is a travesty. The
experiment of drilling in the hall without any boots at all was made in one school where the footgear
was generally bad, and the teachers reported that the result was most satisfactory.
The poison of rheumatism is widely distributed. One of its symptoms not infrequently
noticed in schools is chorea or St. Vitus's dance, but the symptom of the most serious nature
is the heart disease which is often found among the results of rheumatism. Profound anæmia,
febrile disturbances and illnesses which come and go in children may all be due to this disease and
probably overlooked rheumatism in childhood is one of the most fertile causes of debilitated health in
adult life. Dr. Langmead has attempted to investigate the prevalence of rheumatism among 2,55G
(844 boys, 838 girls, and 874 infants) of the children in schools at Baltic-street, Ann-street, St. Anne's
(Dean-street) and Grafton-road. His proportions show the smallest possible results as he only noted
those presenting definite evidence and omitted merely suspicious cases.

Rheumatism.