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129
Report of the County Medical Officer—Education.
The shifting of sex incidence is probably due to the inclusion of rickets, which is more prevalent
amongst boys at the younger ages, and to the increase at the older ages of minor degrees of spinal
curvature, which is more prevalent among older girls.
Squints.—The vision of infants cannot be tested in school, but during the third term of 1912
squints were recorded separately for each age group, and for the first time we are enabled to state the
number of infants entering school who have already developed this condition.
Out of 13,144 entrant boys the number with squints was 251 or 1.91 per cent., and out of 13,269
entrant girls examined the number with squints was 272, or 2.05 per cent. It is of importance to note
this fact, inasmuch as the proportion of squints found in the 8 to 9 group of children is less, amounting
to 1.6 per cent. boys and 1.5 per cent. girls. It would, therefore, appear that in spite of
school work, involving the close use of the eyes, there is a tendency towards restoration during
school life of the co-ordination of the eyes in children in whom it has been disturbed before admission
to school.
Vision.—The number of children failing to reach the acuity of vision regarded as normal
is only available for the third term of 1912, and during this term practically only the middle
age group was being examined. The percentage of children during the whole year who were
referred for treatment on account of the condition of the eyes was 10.62 boys and 11.30 girls in the
middle age group, and 14.57 boys and 16.10 girls in the older group. These figures include cases
of external eye disease, but it may be taken that the incidence of the latter is fairly constant in each
sex and age group, and that the excess of numbers referred for treatment at the older age group is on
account of the larger amount of visual defect. The greater incidence upon girls is also noteworthy
in connection with the theory that some amount of visual defect is caused by excessively fine work
in school, which of course is more marked amongst older girls who do fine sewing.
When considering the numbers of children referred for visual defect, however, it should be made
clear that the standard of defect requiring treatment has been higher in the older age group than in
the middle age group, and (apart from the sex incidence) these numbers cannot be taken to throw any
light on the vexed question of how far visual defect is caused by modern school conditions.
Tuberculosis.—There is very little variation from the average of 0.31 per cent. for all children
inspected to be noted in the percentages of cases of pulmonary tuberculosis found at each age during
routine inspection. The lowest percentage during the past year was 0.23 recorded in entrant boys, the
corresponding percentage in entrant girls being 0.30. In the middle-age group the percentage was
0.32 in boys and 0.36 in girls, and in the oldest age group 0.36 and 0.31 for boys and girls respectively.
Other forms of tuberculosis were found more frequently in the middle-age group than in the younger
or older children. The percentages in the middle age group were 0.30 and 0.37 in boys and girls
respectively, as compared with 0.24 and 0.20 in the entrant group, and 0.23 and 0.15 in the oldest age
group. Many of the older children suffering from tuberculosis of the bones and joints are, of course,
drafted into schools for the physically defective, and therefore do not appear in the statistics of routine
examinations.
Defects of the nervous system are found most frequently in the middle age group, amounting to
1.29 per cent. in boys examined and 1.24 per cent. in girls, the corresponding figures in entrants being
0.75 and 0.80 per cent. and in the oldest group 0.75 per cent. and 0.93 per cent. in boys and girls
respectively.
Similarly a greater incidence of speech defects is discovered amongst children of the middle-age
group, although the age variation is here over-shadowed by the sex variation—boys, as previously pointed
out, being considerably more prone than girls to suffer from defects of articulation.
The percentages of cases of stammering in boys are 0.26 in entrants, 0.62 in the middle age
group, and 0.57 in the oldest age group. The corresponding percentages in girls are 0.15, 0.21, and 0.18
for the entrant, middle and oldest age groups respectively.

Clothing, nutrition, cleanliness and teeth.—In accordance with the schedule of the Board of
Education the condition of all children with regard to clothing, nutrition, cleanliness and teeth is
classified into good, average and bad. The percentages of the figures resulting from this classification
have been set out for the different boroughs of London. In making a comparative estimate of
this kind the school doctor or school nurse is naturally influenced by the condition of the children as a
whole whom he is at the time engaged in examining and the estimate of good, average or bad can
only have reference to his recent experience. While such estimates, therefore, have some value in
directing the attention of the care committees and head teachers to the cases in each school most in
need of special consideration, and some value in comparing the conditions of a particular school with
others in the same school doctor's area, it is clear that no special significance can be attached to
them for the purpose of comparing district with district. In the aggregate, however, such estimates
are of some value in comparing the conditions according to age and sex.
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