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Report of the County Medical Officer—Education. 115
The cases of squint among infants form 40.4 per cent, of "external eye diseases," the
percentage is 37.1 among children aged 8-9, and it falls to 34.8 among leavers. There is a heavier
incidence on boys in each age-group. Blepharitis accounts for 24.8 per cent, of eye disease among
entrants, 21.5 per cent, among children of the 8-9 age group and 28.6 per cent, among leavers.
Conjunctivitis forms about 10.8 per cent, of the eye diseases in each of the three age groups.
Cases of ophthalmia numbered 66 in these three boroughs, the majority of them being among
the entrants ; other eye diseases were noted in 136 cases, forming 11.3 of the eye diseases in these
boroughs. These cases include keratitis, iritis, ptosis, and cases of epiphora, severe eye strain, etc.
Keratitis, or corneal ulcer, was reported in 237 cases among school children inspected in
London, including special and urgent cases. Of these cases, 13 were reported as being interstitial
keratitis, the majority of these cases being urgent cases specially selected because of some evidence of
specific disease. The figures for the inflammatory conditions included under the heading of external
eye diseases cannot be taken as in any way representing the total incidence of these diseases in the
elementary school population. Such conditions being often exceedingly painful, the children are out
of school, and do not, therefore, come under the notice of the school doctor. Of children out of
school for prolonged periods on account of ill-health 8'7 per cent, are returned as suffering from
diseases of the eyes. (See p, 149).
Dr. W. J. M. Slowan, who has made notes upon cases of inequality of the pupils of the eyes
in 5,000 children inspected by him, points out that when the opposite sides of the body are critically
compared, defects in symmetry may often be discovered, which would not have been detected
by a cursory inspection. These defects are frequently found apart from any question of pathological
causation, and can only be regarded as personal peculiarities.
Dr. Slowan a
report upon
asymmetry
of pupils of
the eyes.
Amongst tnese variations differences in the sizes or the pupils are found in a certain
number of cases, and various theories have been advanced to account for these inequalities of size.
Thus it has been suggested that in the case of irides of different colour the less pigmented eye will
have a smaller pupil as more light will reach the retina. But as a matter of fact the irides are
practically always found to be of the same colour in the case of unequal pupils, and in any case
light falling on either retina stimulates the reflex pupillary centre for each eye equally. Again, it
has been suggested that the presence of glandular enlargements in the neck might, by acting on the
sympathetic nerves, cause inequalities in the pupils, but nothing has been noted in this investigation
that would support this theory.
A considerable number of cases is met with in which there is apparently no reason for the
occurrence of asymmetrical pupils, but as will be seen from the following analysis certain facts have
been elicited. Thus while boys and girls appear to show this abnormality in equal proportions, it is
found in three times as many blue eyed as brown eyed children, and the left pupil is larger than the
right in the large majority of cases, when the condition of inequality exists. Unfortunately,
Dr. Slowan does not give the proportions between brown and blue eyes amongst the normal children
he examined.
Among the 5,000 children examined by Dr. Slowan, inequality of the pupils of the eyes was
observed in 107 cases, or 2.14 per cent, of the whole number. These cases have been analysed as
follows:—
Of 51 Boys the left pupil was larger than the right in 35 cases.
Of 56 Girls do. do. 42 „
Of 107 children the iris was blue in 83 cases.
Do. do. brown in 24 „
In 10 cases out of the 107 vision was defective, and in each case the left pupil was larger
than the right. Eight of the children had blue, and 2 had brown eyes. Of the blue-eyed children,
in 6 cases the vision of the eye with the larger pupil was the more defective, in 2 cases the less
defective. Among the brown-eved children the proportions were equal.
Height and weight.—The heights and weights of children are ascertained at the time of the
medical examination. In the annual report for 1912, the average heights and weights of children
aged 8 and 12 in the elementary schools in London were given and compared with similar figures for the
whole of England. The figures then published showed that at the earlier age the boys were both
taller and ^heavier, while in the later age-group the girls had the advantage in both height and
weight.
Anthropometrical
measurements.
The following table shows how the average weight increases with each addition of five
centimetres to the stature. Age has little influence on the weight if the stature remains the same.
A child of 5 years of age whose height is 105-110 centimetres will weigh nearly as much as a child
of the same height at 8 years of age, and a child of 8 whose height is 125-130 c.m. will weigh but
slightly less than a child of 12 years of age having the same height.
In order to compare the weights of children in each of these groups of stature, differing by 5
centimetres, the average height of the children in the group is shown, as it is obvious that in a group
of children of 110-115 c.m., all aged 5, the greater part of them would be nearer 110 c.m. than 115
c.m., and with children of 8, whose height is 105-110 c.m., the greater number would be nearer
110 c.m. than 105 c.m. The figures given relate to measurements of about 6,000 children in various
London Boroughs, comprising 1,000 boys and 1,000 girls in each of the three age groups. It will be
noticed that from 95 c.m. to 105 c.m. the weight increases by about 1 kilogram for each increase of 5
centimetres in height; from 105 c.m. to 125 c.m. the increase in weight is about 1½ kilograms
per 5 c.m., and from 125 c.m. to 140 the increase is approximately 2 kilograms for an increase of
5 centimetres in stature. On the other hand an increase of age from 5 to 8 years, the height being
constant, means an increase in weight of 1 kilogram.
23610 Q 2