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128
Annual Report of the London County Council, 1912.
Special and
urge nt cases
Certain children not in the age groups coming automatically for examination selected for special
medical examination because of some more or less obvious defcct or symptom of disease detected by the
head teacher, the school nurse, school doctor or representative of the school care committee, and
occasionally at the request of the parent. These cases, being selected, cannot be taken as a basis for forming
any judgment of the general health of school children, and the relative proportions of such cases in the
various districts must depend to a certain extent on the energy or powers of observation of the head
teacher or care committee representative.
During the year 10,616 special cases were examined, and of these 6,816 (64.2 per cent.) were
referred for treatment. (Appendix XII.)
Among the special and urgent cases the children with skin diseases formed 5.3 per cent., children
with defective teeth requiring treatment 9.9 per cent., cases of adenoids or enlarged tonsils requiring
treatment 14.6 per cent., children needing treatment for diseases of the eyes or defective vision
21.9 per cent., diseases of the ears or hearing 9.4 per cent., heart affections 5.2 per cent., anæmia
3.7 per cent., phthisis 1.8 per cent., while 2.4 per cent. of the children had deformities, and 0.67 per
cent. were found with malnutrition.
Many special cases were examined at various schools or centres on Saturday mornings. These
cases were referred by the school care committee, the head teacher, the divisional superintendent or the
school doctor himself. A large number of these cases were children who for one cause or another had not
recently been attending school. Other cases elder children leaving school, were examined as to fitness
for some particular occupation, while a number of children, contacts of cases of phthisis, were specially
examined to ascertain whether they presented symptoms of this disease. Children who have been in
contact with cases of infectious disease are also examined to ascertain whether any signs of infection
are present. 450 children were examined at these inspections during the third term and 164 cases
were referred for treatment. The following defects were found:—
Skin defects, 3; defective teeth requiring treatment, 28; enlarged tonsils, 27; adenoids, 22;
defects of throat and glands, 14; eye diseases, 23; squint, 10; defective vision requiring treatment
54 ; disease or discharge from ears, 12; defective hearing, 4; heart affections, 18; anaemia, 21; lung
complaints. 49: phthisis. 29: deformities. 13: rickets. 1: malnutrition. 3: other defects. 13.
Comparison
of age
groups.
Comparison of age groups.—The results of the complete examination of all children at three
age groups should give comparative figures of considerable value as bearing upon the effect of school
life in ameliorating or aggravating various defects. (See Appendix XII.)
The percentage of children referred for treatment for enlarged tonsils and adenoids tends to
diminish during school life. The highest percentages, 10.73 boys and 9.20 girls, are found amongst the
infant group, falling to 8.76 boys and 8.61 girls amongst the middle age group and to 7.92 boys and
8.68 girls amongst the oldest group.
Discharging ears are highest amongst the entrant infants (boys 2.47, girls 2.46) and lowest amongst
the oldest children (boys 1.98, girls 2.03). Defective hearing, on the other hand, shows an increase
during school life from 1.06 per cent. boys and 1.23 per cent. girls amongst infants, to 1.90 per cent.
boys and 2.10 girls in the middle age group and 2.21 per cent. boys and 2.19 per cent. girls in the oldest
group. Some allowance in the case of infants must, no doubt, be made on account of the difficulty
of discovering subjective defects among them, but on the whole these figures appear to indicate that the
attention which defects of nose, throat and ears now receive has resulted in a progressive amelioration
during school life of primary conditions, but that the secondary results as shown in defective hearing
accumulate and that many children suffering from the primary defects are still not detected or brought
under treatment early enough to avoid the danger of permanent damage.
Heart disease tends to increase during school life, being found in 1.85 per cent. boys and 1.73 per
cent. girls amongst infants and in 2.24 per cent. boys and 3.01 per cent. girls amongst the older children.
This is again probably to be explained by the cumulative results of attacks of rheumatism, scarlet
fever and chorea. It must be remembered also that a large number of the more pronounced cases of
heart disease at the older ages are either excluded from school or drafted into physically defective
schools.
Diseases of the lungs (other than phthisis) on the other hand are found in considerably larger
proportions among the younger children, being recorded in 4.58 per cent. boys and 4.45 per cent. girls
amongst infants, 3.75 per cent. boys and 3.40 girls in the middle age group, and 1.55 per cent. boys and
1.42 per cent. girls in the oldest group. This preponderance in the younger children of lung trouble
is due to the prevalence of bronchitis associated with rickets.
Rickets—The number of children reported as suffering from the effects of rickets is naturally
highest amongst the entrants, 2.77 per cent. boys, 1.44 per cent. girls; with increasing age the effects
of this disease become less easily recognisable and only 1.19 per cent boys and 0.80 per cent. girls are
reported amongst the oldest group. It has been pointed out that many of the deformities found
amongst entrants are really the effects of rickets although they have not been classed under that
heading and the number of infants suffering from the effects of rickets would probably be still higher
than these figures show.
Deformities.—In spite of the fact above mentioned that the number of deformities among infant
children is swollen by the inclusion of certain cases which should be properly classed as rickets, the
percentages of deformities show a tendency to increase during school life. Amongst entrants 1.35 per
cent. boys and .74 per cent. girls are reported; in the middle age group 1.87 per cent. boys and 1.97 per
cent. girls, and in the oldest age group 1.61 per cent. bovs and 2.32 per cent. girls. It is to be remembered
that many children at the older age group suffering from grave deformity are out of school or
drafted into schools for the physically defective.