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Report of the County Medical Officer—Education.
123
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earlier age-group and among girls at a later age. The higher incidence among infant boys is
probably due in a large measure to deformities following rickets in earlier life, though no history of
rickets was noted, while the greater presence of lateral curvature of the spine accounts for the excess
of deformities in older girls.
In Hampstead, Islington, and Shoreditch, 287 children with deformities were noted, and 63
recommended for treatment. Lateral curvature of the spine accounted for 124 of these cases,
occurring chiefly among elder girls. Lordosis (hollow back) occurred in 15 cases and kyphosis
(round shoulders) in 18 cases. Here again the elder girls were more frequently affected. 9 children
were reported to be club footed. Torticollis or wryneck was noted in 8 cases in these three
boroughs.
Infectious diseases.—Under the head of infectious diseases are included cases of notifiable
disease, measles, whooping cough and chicken pox; but impetigo, scabies, ringworm and other infectious
skin diseases are not included. It is comparatively rare for the acute diseases to be debected
at routine medical inspections but some cases of measles, chicken pox or whooping cough and a
few mild cases of scarlet fever are found on these occasions by the school doctor. An examination
is made of contacts of cases of scarlet fever and diphtheria, which are reported to the head
teacher under the provisions of the Public Health London Act, 1891. The casee of infectious
disease found by the school doctors on routine visits numbered 323 (0.16 per cent, of the children
examined). Of the 323 cases 232 occurred amongst the infants.
Skin defects and diseases.—The term "defect" includes the presence of vermin or nits on the
head or body of a child. 10,901 such cases were found by the doctors on their routine visits. Of
these cases 1,875 occurred among boys and 9,026 among girls, the proportion of cases of nits
present being as might be expected much greater amongst girls than amongst boys. The defects
among boys declined as the age increased, whereas with girls the reverse was the case, 7.6 per
cent, occurring among entrant girls and 9.5 per cent, among leavers. It must be remembered that
notice of the medical inspection is given to the parents and many of the children come to school
specially prepared for the occasion.
The Council's nurses visit the schools under the scheme for dealing with verminous children,
and as no notice is given of these visits, a much better notion of the ordinary conditions in regard
to cleanliness is to be obtained from their reports, a summary of which appears on page 86.
Skin diseases.—These include ringworm, impetigo, and scabies in addition to all non-contagious
skin complaints. 3,733 children were found with skin diseases and 1,559 were referred for

With increasing age there is a steady decline in the number of cases of skin disease. Boys
and girls were equally affected. In Islington, Hampstead and Shoreditch the school doctors found
642 children with skin diseases. 301 of whom were referred for treatment.

The figures in brackets represent cases recommended for treatment. Over 60 per cent, of the
severer cases are accounted for by the four complaints enumerated above. In addition to these there
were 22 (3) cases of urticaria, 24 (4) of psoriasis, 10 (3) of herpes, 19 (6) prurigo, 22 (4) of
seborrhea, 15 (1) ichthyosis. The remainder included cases of dermatitis, xerodermia, and other
minor defects ; 15 cases of alopecia were noted.
Malnutrition.—Children marked as "nutrition 4"—i.e., badly nourished children—are invariably
referred for treatment, and in addition certain cases in class 3 are kept under observation. During
the year, 1,210 children were regarded as suffering from malnutrition and 1,178 of them were recommended
for treatment. The cases were least common amongst children of the middle age-group.
Among entrants 231 children were allocated to class 4 and 460 were noted as malnutrition
cases, 50 per cent, of the latter being class 3. Among children aged 8-9 years, 185 were grouped in
class 4, and 278 were noted as cases of malnutrition, so that only 33 per cent, were class 3 cases.
The investigation of cases of malnutrition is of great medical importance. It has been the rule
throughout the year to initiate a special enquiry by school doctor and care committee respectively in
every case in which the nutrition is returned as 4 in the medical record. An analysis of 885 cases in
which the enquiries are complete has been made by Dr. C. J. Thomas, and is to be found in a following
section, where special attention has been directed to the history of cases in which tuberculosis is
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