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Report of the County Medical Officer—Education. 171
to find out if there has been an absolute increase in the lung capacity, spirometric measurements must be
made, but as it was impossible to take these, the measurements of the chest during ordinary breathing
and during forced inspiration were recorded. The measurement was in all cases taken at the level of the
nipple. In almost every case an increase in the total girth was observed, though such increase did not
always correspond with a proportionate increase in the measurement during forced inspiration.
In April the highest recorded chest measurement among 21 boys was 215 inches, during ordinary,
and 26.5 during forced inspiration ; the greatest chest expansion recorded was 2f inches. The lowest
chest measurement was 20 inches, and the lowest expansion | inch. The average for the 21 boys was
22.1 for ordinary and 24 inches for forced inspiration. In October the greatest chest measurement
was 23 inches during ordinary and 28 inches during forced inspiration ; the lowest 22 inches for ordinary
and 23 for forced inspiration. The average for ordinary inspiration in October was 24 inches, and for
forced inspiration 25.7, an average increase of 1.7 inches.
The corresponding figures for the girls (17) were as follows :—The lowest recorded chest measurement
in April was 20 inches, the lowest expansion measurement was 201/8 inches, the largest girth was
21 and the largest expansion measured 26. The average was 21.2 for ordinary and 23.5 for forced inspiration.
In October the largest girth measurement was 25, and the largest expansion 27, the lowest
21 and 21.8 respectively. The average for October was 23 for ordinary and 24 for forced inspiration,
an increase of only 0 5. In several cases the chest expansion had not altered, though the girth of the
chest had increased.
To a large extent this increase in the chest measurement is undoubtedly due to the breathing
and other exercises carried out in the class. Defective nasal breathing has been much improved
and the children who were at the first inspection noted as " mouth-breathers " showed an ability to
breathe steadily and without effort with one nostril closed.
In the few cases where the chest measurement showed little or no increase, the weight also
remained nearly stationary. These cases need further watching, although the school doctor could not
find that they presented any special and definite signs calling for urgent treatment. In one case carious
teeth and underfeeding were probably responsible for the lack of improvement; this case is now receiving
attention.
Olga-street (Bethnal Green, N.E.).—This class consisted chiefly of backward girls taken from
one standard, but there were also some delicate, sub-normal, and overgrown children of about the
same mental capacity. The class was held under the shelter of a wall in fine weather, but in a shed
in Wet weather. The children appeared to have improved mentally to a certain extent, and seemed
brighter and more attentive. The majority improved in their physical condition, gaining weight and
increasing in height, four remained stationary in height, while three lost weight.
At the last inspection twelve children appeared to be normal, eight had made marked improvement,
and four noted originally as suffering from cough had recovered therefrom. Of the four whose
weight was stationary, one had lost cough, one coughed less, one was less anaemic. One child who was
suffering from chlorosis and who was very sub-normal in height, improved markedly in colour and
grew one centimetre in the last two months.
Peckham Rye (Peekham).—This class was made up of children who should be in Standard I.
(average age 7½), and who were sickly and delicate. The lessons were given under a large shady tree
in the playground if fine,or if wet. under the playground shelters of which there were two, so that, in the
event of too bright sunshine or high wind, some mitigation was obtainable. During the summer the class
was never forced to shelter in the school itself. Unfortunately no weights and heights are available, but
the children on the whole were brighter and better, and there was a notable absence of catarrhs in spite
of defective boots and occasional wet feet. There were 30 on the roll, and the average attendance was 28.
Eleven children had very defective boots (that would not keep out water), and half the children were
given milk in the middle of the morning.
Priory Grove (Kennington).—Thirty-eight boys, nearly all in the 7.8 age group, who were not
" picked " in any way. The average increase in weight was 1.2 kilograms, and in height 3 4 centimetres.
Great improvement was noticed in cases of anaemia, and the school doctor pointed out especially the
improvement in nasal catarrh with lessening of the habit of mouth-breathing.
Queensmill-road (Fulham).—The class was held in a very open playground with a convenient
roofed shelter. No special selection was made, one of the school classes being taken as a whole. The
class was a complete success.

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