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110
Annual Report of the London County Council, 1913.
The condition of clothing was generally better among girls than among boys, and nutrition
was also slightly better among girls. The heads of girls were more frequently found to be
unsatisfactory, but in general cleanliness of the body girls were reported to be better than boys.
Cases for medical treatment.—In Appendices II to V tables are given showing the number
and percentage of cases referred for treatment in each of the three age-groups for the schools in each
of the London boroughs. From the tables it will be noticed that 72,437 children, or 36.8 per cent,
were referred for treatment out of the 197,158 children examined in the three age-groups. Among
entrants the percentage was 29.7, among the children aged 8-9, 41, and among leavers 42.2. The
eyesight of entrants is not tested, and this accounts in a large measure for the smaller percentage of
this group being referred for treatment. Among girls the number of cases was slightly higher
than amongst boys, the percentages being 37.1 and 36.5 respectively. Woolwich, Southwark,
Poplar, and Shored itch show the largest proportion referred for treatment, and Hammersmith,
Lewisham, Kensington, and Marylebone the lowest. In Woolwich a large percentage of dental cases
accounts for the high figure.
Vision.—The vision of children aged 8-9 and of leavers is tested by means of the Snellen
types at a distance of six metres, each eye being tested separately, and in addition to the determination
of the acuity of vision special note is made of any cases of eye disease or squint. In the
testing of vision a difficulty is sometimes experienced with children in the intermediate age-group
who are not familiar with the letters, and this may to some extent account for the fact that so many
children in this age group fail to read the six-metre type at the proper distance. The next sized
type is one that should be read by the normal eye at a distance of nine metres, and the other sized
types at 12, 18, 24, 36, and 60 metres respectively. The vision in the tables in the Appendix is
classed as follows: (1) Children with normal vision, i.e., those who read the smallest type at six
metres (6/6) with both eyes tested separately; (2) children who read at six metres the type normally
read at nine metres (i.e. -6/6-) with one or both eyes ; (3) bad vision, i.e., children who read at six
metres the type normally read at 12 metres (6/12). or worse in one or both eyes.

If the child wears spectacles the vision is tested whilst the glasses are being worn. As a
general rule children whose vision is or worse in either eye are referred for treatment unless the
doctor is satisfied that improvement cannot be effected. In many cases children, when wearing
spectacles, do not and cannot attain normal vision.
From the above table it is clear that the vision of the elder children, as tested by the Snellen
types, is more acute than that of the younger group, 47.4% of the former having normal vision and
only 34.4 of the latter, but when class 3 is considered it is found that among older children 24.2% have
bad vision and among the 8-9 group the percentage is 20.8.
It has been pointed out in previous reports that there are two processes at work in relation to
visual acuity, as tested by the Snellen types, during the progress of school life. In the first instance
there is a gradual education of the physical and mental powers leading, in the great majority of
children, to an apparent increase in the acuity of vision ; in the second instance there is a deterioration
of vision in a minority of the children due to pathological causes, leading to an increase in the number
of cases at the older ages with severe defect of visual acuity. It has been possible this year to analyse
the whole of the children inspected with regard to the degree of visual acuity, and the resultant
figures here given illustrate very clearly the progress of these two processes during school life.
Dr. Margaret
Mcdonald's
investigation
into the
vision of
infant
children.
Owing to the immaturity of their mental development, and to the fact that there exists no
ready means of testing the visual acuity of infant children, no entry of the condition of eyesight is
recorded in the medical inspection schedule relating to entrants. In the ordinary course of things,
therefore, it is only when children exhibit some gross sign of visual defect, such as squint, that they
come under the notice of the doctor in the Infant department. Dr. Margaret C. Macdonald has
conducted a very careful investigation into the eyesight of 804 infant children in schools under her
care. As, for the reasons explained above, knowledge of the visual conditions of elementary children
under the age of eight is very limited, her enquiry is rendered the more valuable. The report, which is
summarised below, demonstrates the exceedingly great difficulty experienced in investigating the
acuity of the special sense organs in very young children, owing to the quick onset of fatigue and
the lack of development of the higher centres of the brain. In addition to exhibiting the results of
the investigation of the conditions of eyesight of the children, Dr. Macdonald's report contains
interesting comments upon the very surprising variations of daylight illumination encountered in
various parts of one and the same school building.