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138
Annual Report of the London County Council, 1910.

Teeth.—Teeth were very good 13.6 per cent., good 65.3, per cent., average 9.1 per cent., bad and
very bad 12.0 per cent. Those who had bad teeth were chiefly of the better class, so that probably coarse
food and the absence of sweets had to do with good teeth.
Adenoids and Tonsils.—Advice cards were given to 24 boys, 41 girls and 28 infants, though there
were many other slight cases in which operative interference was not deemed necessary, but in which
verbal advice was given to the parents.
Dirt Diseases.—Vermin have been already referred to. No case of scabies was seen. Impetigo
contagiosa was not uncommon; there was little ringworm and most cases of neglected dirt conditions
seemed to be blepharitis of slight degree.
Circulatory Conditions.—Many anaemic children presented functional cardiac murmurs.
The numbers noted with anaemic or other circulatory defects were: Boys, 45 (15.4 per cent.); girls
111 (39 per cent.); infants, 109 (34.6 per cent.).
Pulmonary Conditions.—Signs of catarrh or bronchitis were noted in 22 boys, 28 girls and
32 infants. The diagnosis of early pulmonary tuberculosis is most difficult. There were three doubtful
cases. One boy of 13 with definite signs in the lungs was examined by the house physician at hospital,
who wrote a somewhat sarcastic letter asking for details; these were furnished and elicited a more
oourteous reply, asking for the boy to be sent back. He was sent back, kept waiting for some hours and
sent away without further examination. As he left school the case could not be followed up, but both
parents were dead, and the mother was said to have died of chest disease. The next case, a small,
miserable boy of 7, was sent away from the hospital, as having nothing wrong with him. He was put
on oil and milk at school and for some weeks temperatures over 99.5 were registered in the afternoons,
justifying the diagnosis. Ultimately the feverishness gradually diminished and disappeared. On
the other hand a girl of 12 noted as merely anaemic broke down later and was treated at the
hospital for tuberculosis. A family history of phthisis was often elicited from the parents of many
quite healthy children. Only 17 out of 36 girls with such history could be even called delicate and
only 7 out of 19 boys. On the other hand, 159 cases with good family histories seemed likely cases
to develop tubercle later.
Spinal Curvature.—In 100 of the girls there was some slight departure from normal, but no
serious case of spinal deformity. Lordosis is however developed by false ideas of the teachers on the
erect attitude. A flabby anaemic child standing incorrectly at attention tends to develop this
deformity.
Flat-Footedness.—Flat-footedness or weak feet were noticed in about 75 per cent, of the boys
and 63 per cent. of the girls. They were mostly anæmic children and the condition seemed to remedy
itself with better nutrition and exercise.
Care of the
Teeth.
"The importance of this subject is not likely to be over-estimated." This was the first sentence
on dental matters written in these reports some half-dozen years ago. It is not possible to add to
the accounts of the terrible but common oral conditions reported on since then in the London schools.
Five years ago, after visiting municipal dental surgeries in connection with schools in foreign towns,
dental caries was reported as the most widespread affection among the population, and one which
seriously affected the working capacity and even the earnings of large numbers of people. "Dental
hygiene must be taught in school, but the Continental experience shows that examinations and
teaching are useless unless followed by the practical measures of inculcating and enforcing cleanliness
among the children and providing remedial treatment. The affection is so insidious and so widespread
that it should be met by public provision. There is no way of dealing with money in the
interests of public health which will return so enormous a gain to the population for the same small
expense required as this matter of school dentistry." There are now 80 towns in Germany with
(a) Had an extra meal of milk and oil at 11 a.m. during winter. Nos. 2, 3, 6, 7, 8, 13 were marked as likely
to become tubercular.