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12")
Report of the County Medical Officer—Education.
fairly evenly distributed amongst boys and girls, and no special incidence appears to be associated with
any locality or with any particular class of children. The proportion of cases referred for treatment
varies from 4.6 per cent. in Bethnal-green to 18 per cent. in Woolwich, but it should be noted that while
Bethnal-green shows only 4.6 per cent. the adjoining and similar borough of Shoreditch shows 16 per
cent. Finsbury has 6.6 and St. Pancras 5.4 per cent. The difference is no doubt mainly due to the
varying standards adopted by the school doctors.
Other detects ot the nose or throat were tound in 5,720 or 2.4 per cent. of the children examined
in detail. Of these 1,324, or 0.55 per cent, of those examined, were noted as requiring treatment.
Glands.
Enlarged glands.—During the year 12,969 children (Appendix XTI.) or 5.4 per cent. of the children
examined were found with diseased or swollen glands. Of this number, in only 1,695, equal to an
incidence of 0.7 per cent, was the condition regarded as severe enough to require treatment. The proportion
of cases noted as requiring treatment in Shoreditch was 3 per cent.; in Deptford, Kensington
and Bermondsey, from 1.9 to 2.4 per cent., while in Bethnal-green and Finsbury 0.14 and 0.5
per cent. only were noted. During the third term of the year defects of the sub-maxillary
and cervical glands (which form the bulk of the cases) were classed separately from those of
other glands, and during this term only 197 cases of glands other than the cervical or sub-maxillary
were noted as enlarged, and 30 were referred for treatment out of 90.000 children examined.
Ears and
hearing.
Ear disease.—Defects in hearing are classed separately from diseases of the ear or discharging
ears, but with regard to the figures for treatment which include both classes, a child that has
defective hearing due to disease or discharge is not counted for both the defect and the obvious
cause of that defect.

The percentage of children with defective hearing in Shoreditch was 4.9 and in Bethnal-green 1.5.
This corresponds with the percentage of cases of adenoids. The close connection between adenoid
growths and defective hearing may be demonstrated by taking the random case of the Hoxton electoral
area, where during the third term, 69 children were reported to be deaf. Of these 69, 44 were reported to
have adenoids and eight had enlarged tonsils. Thus, only 17 cases of deafness occurred in this area in
which the defect was not associated with adenoids or enlarged tonsils.
Speech.
Speech.-—Stammering and other defects of speech such as lisping are noted. Very few of these
cases are referred for medical treatment owing to the absence of the necessary facilities.
During the year 771 (or 0.3 per cent.) cases of stammering were noted at routine inspection. 561
were boys and 210 girls. As in former years the disproportion between the sexes was marked. A
similar disproportion, though to a slighter degree, was noted among the children having other defects
in speech. The boys show 991 cases and the girls 668. The cases requiring treatment were :—
stammering—bovs. 98: girls. 31; other defects of sneech—bovs. 40; girls, 31.
Heart
Disease and
Amæmia.
Diseases of the heart, valvular lesions and other defects were noted in 5,454 cases (2.3 per cent.),
1,134 being referred for treatment.
5,228 (2.2 per cent.) children were found to be anæmic, and of these 2,096 were considered to require
treatment. Among the infants there Were more anaemic boys than girls, but in the other age groups
the number of girls was greater, indeed among the children of the age groups 8-9 and 11-12 referred
for treatment for this cause, the number of girls to be treated was 797 and the number of boys only 484.
Lungs.
Diseases or defects of the lungs (exclusive of phthisis) were noted in 7,828 (3.25 per cent.) children,
2,957 (1.23 per cent. of the number examined) of whom were referred for treatment. In Shoreditch
the percentage was 9.7 cases found and 5.5 referred for treatment, and in Bermondsey 5.9 per cent.of
cases found, and 3.0 per cent. referred for treatment, while in Lewisham, the percentages were 0.6
and 0.1 respectively.
Nervous
Diseases.
Nervous defects were noted in 2,247 children (0.9 per cent. of those examined) and 637 of these
were reported to reauire treatment. The cases were fairlv evenlv distributed between the sexes.
Tubercular
diseases.
Tubercular diseases.— 740 (.31 per cent.) cases of phthisis were noted at routine examinations, and
439 of them were referred for treatment. The cases for treatment were: boys, 203; girls, 236. In
addition to these cases 188 (1.77 per cent.) children among the special or urgent cases were found to
present symptoms of phthisis and 111 of these were referred for treatment. (Appendix XII.)
Tubercular diseases, other than phthisis, were noted in 585 children in the three age groups,
and in 108 children among those specially examined. Of these 693 cases 222 were referred for treatment.
Comparing the various districts the highest phthisis case-rates occur in Shoreditch (0.61), Finsbury
(0.60), Fulham (0.53), and Holborn (0.52). The lowest in Stoke Newington (0), Lewisham (0.04)
Hammersmith (0.16), St. Pancras (0.16), and Wandsworth (0.18).
Rickets.
Other tubercular diseases were reported most frequently in Stepney (0.62), Holborn (0.48)
and Finsbury (0.48 per cent.); the lowest rates were in Lewisham (0.06), Greenwich (0.07), and
Stoke Newington (.07). (Appendix X.)
Rickets.—4,074 (1.69 per cent.) children were noted as having rickets. Of these 2,634 were boys
and 1,440 girls. The proportion was found to be highest among the "entrants" and lowest among
"leavers." The percentage was as low as 0.3 in Lewisham and Greenwich and as high as 4.5 in Hackney
and 5 in Hampstead.