London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1912

[Report of the Medical Officer of Health for London County Council]

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127
Report of the County Medical Officer—Education.
Feeding was provided at school for 95 of these cases, 81, being necessitous and 14 being cases in
which the children's parents themselves desired to pay for milk meals.
Of the 74 cases in which underfeeding was adjudged the chief cause, 46 were placed on the feeding
list for the first time as a result of the medical examination, 16 were already being fed, and 12 were, for
various reasons, not fed at school. Among the cases of the 16 children who were already being fed the
following additional measures were taken in consequence of the medical report. Milk or cod liver oil was
given in addition to dinners in eight cases, convalescent treatment obtained for two, and hospital
treatment for two. In the 12 cases not placed upon the feeding list the following measures were
taken—for 4 children hospital treatment was obtained, for two, a county holiday was arranged, in
two cases the home conditions had improved and parents were able themselves to provide extra
nourishment, one child was out of school but was fed on return, in one case the question of providing
milk meals is now being considered by the care committee, one case was referred to the
organisers for further report, and for one child milk and cod liver oil were obtained from outside
sources. In the case of the 42 children whose malnutrition was due to illness other than tuberculosis,
amongst which convalescence from infectious disease and suppurating ears were noticed, the following
measures were taken—Provision of free milk meals at school 2, of milk meals paid for by parents
8, of extra nourishment from other sources 11. Medical treatment at a hospital or health centre was
arranged for in 16 instances, a country holiday in 3, while 2 were nominated for admission to special
schools. One child of the 42, whose malnutrition was due to illness, died not long after the condition
was diagnosed. In the 40 cases in which tuberculosis was suspected, or actually diagnosed the
following measures were taken—In 25 cases cod liver oil, malt and milk were provided at school;
19 of these cases were necessitous, and the parents contributed in the case of the other six.
Twenty cases obtained sanatorium, dispensary or other medical treatment, one was nominated for a
physicallv defective school, and one case in which neglect was suspected at home was reported to the
special officer for visitation. In all these cases the sleeping accommodation in the home was investigated
and advice as to management in this and in other directions was given. All these cases are still being
kept under careful observation. Of the 24 cases in which prenatal or congenital conditions had been
the chief cause of the malnutrition extra nourishment was provided in four cases, medical treatment
arranged for in four, while in the others, mainly coming from good homes, it was considered that no special
action was necessary as the parents were fully aware of the delicacy of the children and had taken all
possible care of them. Among the eight cases in which neglect appeared to be the chief factor one was
removed to a remand home, one to one of the scattered homes of the poor law authority, two were
reported to the National Society for Prevention of Cruelty to Children, and in one case where the parents
were addicted to alcohol, meals were given at school and steps taken for the recovery of the cost. The
remaining three were reported to the "special" officer, an improvement being reported after visiting
in two of these cases.
Seventy of the 200 cases have been re-inspected by the school doctors, and of these 36 are reported
as being improved. The improvement in some cases has been such that the children can no longer be
classed as ill-nourished. The improved condition was observed in 15 after milk meals and cod liver
oil had been provided at school, in 13 after attention had been given at home to the suggestions of the
school doctor and care committee, in seven after medical treatment, and in one after a country holiday
had been provided. Two of the cases re-inspected are reported to have lost ground, one being a phthisis
case under treatment, and one being a case where home conditions are unsatisfactory.
Skin defects.
Diseases of the skin.—Under this heading are classified cases of such skin diseases as impetigo,
eczema; parasitic diseases as scabies and, for the third term, figures relating to the presence of nits in
the hair are included. Ringworm cases are for the most part excluded from school by the nurses, who
examine children of all ages for this complaint, and it is comparatively rare for a case to be discovered
for the first time by the doctor at routine examination. Figures relating to ringworm will be found in
another part of the report (p. 156).
The "skin defects" found by the doctor numbered 8,109, and 1,896 of these were noted as
requiring treatment. Of these 8,109 defects. 5,152 or 64 per cent. were among girls, but the girls had
only 44 per cent. of the cases referred for treatment. This difference between the percentages is
accounted for by the fact that nits were found to a greater extent among girls, while the ordinary skin
diseases which would provide the cases for treatment were more prevalent among boys.
Other
defects.
Other defects.—The examination of children in the three age groups disclosed 6,327 defects other
than those named in the tables. 3,017 of these cases were referred for treatment. 605 other defects
were found among the special or urgent cases and 339 of these were noted for treatment. The cases
include debility (when not associated with malnutrition), diseases of the digestive system, urinary diseases,
hernia, abscesses, etc.
In comparing the figures for various districts it should be borne in mind that the elementary
school population is somewhat different from the school age population in relation to social conditions.
In the County of London 72.2 per cent. of the children of school age (3-14) (census 1911) are on the
roll of the elementary schools. In Shoreditch the percentage is 79.2, Bethnal-green 78.3, Poplar 77.0,
while in Hampstead it is 49.7, Lewisham 59.3, Kensington 66.1. In Kensington the elementary school
population resides chiefly in North Kensington, while Hampstead elementary school children reside mostly
in the Kilburn and West Hampstead divisions of the borough. The social conditions of these districts
approximate more to the general London average than is the case when the whole of each of these
boroughs is considered. In Lewisham, on the other hand, the schools are more evenly distributed
throughout the borough, and the elementary school population is more similar to the school age
population.