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Report of the County Medical Officer—Education.
109
and of shortage of cases which the system throws upon the treatment centres. Thus, for instance,
the inspection of infants produces very few cases referred for treatment for visual defect, and, in
consequence, there is some difficulty in making full use of the centres during the latter part of the
summer term, so far as treatment for eyes is concerned ; whereas towards the end of the Easter term
there is a tendency to congestion of cases. It would, therefore, be of considerable advantage if
arrangements could be made whereby some of the children of each age group could be examined in
each term. The difficulty in the way of making such arrangements arises from the fact that the Code
requires that all entrants must be examined during the educational year in which they enter school.
Inasmuch as the educational year ends in July, and a very large proportion of entrants attends school
for the first time during the summer term, it is necessary if the Code is strictly to be carried out,
for the work during this term to consist largely of the inspection of this age group.
Special and urgent cases are examined at any time the school doctor visits a school; in addition
arrangements are made for special cases to be sent for examination to other schools in the neighbourhood
where the school doctor is in attendance, or to some convenient centre, while exceptionally
difficult cases, more especially of visual defect or aural disease, are refarred for expert examination at
the head office. The record of medical inspection of each child is entered on a card which is kept in
the school, and the information on the cards is summarised and shown in the tables in Appendix II.
Presence of Parents at Inspection.—A parent or relative of the child was present at inspection
in 138,236 cases or in just over 70 per cent. The percentage among entrants was 79.7: among
children aged 8-9, 68.6 ; and among leavers, 57.9. In the case of girls in the last age-group a parent was
present in 63.4 per cent, of the cases and among boys in this group a parent was present in 52.3
per cent, of the examinations (see Appendix I).
The interest shown by parents in the school medical inspection of their children is strikingly
illustrated by the fact that when entrants were examined, in such boroughs as Southwark, Bermondsey,
Camberwell, Shoreditch, and Westminster, in over 80 per cent, of the cases the parent
made it convenient to attend, although to a large extent in these boroughs both parents are in
employment. In Holborn the percentage was lowest ((34.2), in no other district did the percentage
fall below 70 when entrants were being examined.

The time devoted to medical inspection by the doctor gives on the average about six minutes
per child and for the nurse about eight minutes per child. It is thus found possible to examine
about 25 children during a session of 2½ hours. This rate of examination, however, places a considerable
tax upon the officers engaged continuously in inspection.
Children are classified as to the condition of their clothing, state of nutrition, cleanliness of
head and body, and condition of teeth (see Appendix I). The classification is made into three
groups, "good" "average" "bad," except in the case of nutrition, where the grouping is in four
divisions, good, normal, sub-normal, bad (i.e., malnutrition;. In the tables in the Appendix (p. 124)
the percentage of children in each group is shown for the schools in each of the London boroughs.
In making comparisons between the various boroughs the question of the general standard of the
neighbourhood must not be lost sight of. Each school doctor must necessarily fix his own standard
from his general experience, and it must inevitably result that what would be termed "fair" in a
good neighbourhood is termed "good" in a poor neighbourhood. Reference to the tables shows
that in Hammersmith Schools among entrants nearly 92 per cent, were classed as having good
clothing, and 0 3 per cent, as having bad; the corresponding figures for Hampstead were 48 per cent,
and 6 per cent. In Battersea 23 per cent, of the entrants examined were reported as having
"bad" teeth: in Poplar the figure was 1.8 per cent.