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156
Annual Report of the London County Council, 1913.
Sufficiency
and suitability
of
dietary.
Refusal of
food.
uses fingers in preference to other means of conveying food to the mouth, every effort should be made
to insist upon both cleanliness and proper table manners.
In this connection the relation between dirty hands used in feeding and suffering from intestinal
parasites should be pointed out. In a recent investigation by one of the school doctors into malnutrition
it was found that 11 per cent. of the children suffered from worms.
The school doctors point out in several cases improvement since last year in both manners and
cleanliness. The hygienic conditions in these respects depend largely upon the character and sufficiency
of the supervision. In addition to uncleanliness of hands, hurrying over meals is a fault somewhat
frequently reported.
Generally the reports are satisfactory with regard to both quantity and quality of the food supplied.
In a few instances the quantities provided seemed insufficient on the date of inspection. With regard
to quality, it appears that while the meals supplied by the cookery centres are most satisfactory, those
supplied by the Alexandra Trust are more reliable than are those provided by local caterers. The
lack of green vegetables, which are so necessary for the health of ill-nourished children, is again commented
upon by several school doctors, and the apparently insurmountable difficulty experienced in
supplying them is to be deplored. It is occasionally reported that the potatoes are served black, soapy
and unappetising. The food supplied by local caterers is very variable, sometimes it is of good quality,
in one or two instances it is upon occasion so bad as to be uneatable.
This was noted in 24 reports. In one or two instances it was justified by the nature of the food
given, but refusal is mostly due either to total absence of appetite in the case of sickly children, or to the
rejection by children of food to which they are unaccustomed. There appear to be local prejudices
with regard to articles of diet, and dishes readily eaten at some centres are disliked at others. Thus,
the rice and currant pudding meal is reported at Trinity Hall, Stewart-road to be the most popular
of all, while at the Eton Mission, Gainsborough-road, some 20 children refused it altogether and about
a third did not finish the quantity given.
In such cases, of course, much depends upon the firmness of the supervisors or attendants. At
some centres an improvement in this respect is recorded. Thus, at Honeywell-road School where refusal
of soup was formerly prevalent, it is now reported that the soup is always well taken.
Tuberculosis.
In the work of medical inspection of school children special attention has been given to the
detection of early cases of tuberculosis, and to bringing such cases promptly under the notice of school
care committees and others actively engaged in securing appropriate treatment. In some boroughs
arrangements have been made with the local medical officer of health to furnish divisional school
medical officers with particulars of child contacts with the cases of tuberculosis notified to them under
the Tuberculosis Regulations, 1912, and special observation has been kept upon these cases by the school
doctors. In Deptford, where the Borough Council have established a dispensary, arrangements have
been made for co-operation between the dispensary and the school medical service and school care
committees. As a complete dispensary system becomes established throughout the county this
co-operation will be extended, and it will be possible to arrange that "contacts" shall, for the
purpose of diagnosis, be dealt with at the dispensaries, and school doctors will refer thereto doubtful
cases when the conditions of school medical inspection do not permit of definite diagnosis. The
question of school attendance or certification for residential institutions will remain the function of
the school medical officer.
The work of the school medical service in connection with open-air schools and playground
classes for debilitated children, and children suffering from tuberculosis in early non-infectious stages,
and also such work in connection with schools for physically-defective children is dealt with
elsewhere in this report. The problem here reviewed is that connected with the position brought
about by the compulsory notification of tuberculosis under the Local Government Board Tuberculosis
Regulations 1912, the establishment of dispensaries by borough councils, and the constitution of the
Council as an authority under Section 64 of the National Insurance Act 1911, for providing institutional
treatment for persons suffering from this disease.
School medical inspection has supplied a considerable number of data as to the nature and
extent of the problem so far as it affects children. During 1913, 809 children, or 0.41 per cent. of
those examined in the schools under the Administrative Provisions Act were found to be suffering
from pulmonary tuberculosis and a further 623, or 0.32 per cent., from other forms of tuberculosis.
The boroughs in which the lowest percentages of pulmonary tuberculosis were reported comprise
Lewisham, 0 04 per cent.; Hampstead, 0.10 per cent. , Greenwich, 011 per cent.; St. Pancras,
0.13 per cent.; Wandsworth, 0.13 per cent.; Lambeth, 0.18 per cent.; Hackney, 0.17 per cent.;
while those with the heaviest percentages were Stepney, 0.94 per cent.; Shoreditch, 0.89 per cent.;
Paddington, 0.84 per cent.; Hammersmith, 0.72 per cent.; Poplar, 0.76 per cent.; Bethnal Green,
0.68 per cent. On the whole it is clear that the incidence of tuberculosis in school children varies
inversely with the average standard of comfurt of the inhabitants of the district. In a report upon
malnutrition as found in school children (p. 50) the close inter-relation of this condition with tuberculosis
is pointed out, and the detailed notes of cases there set out give some idea of the measures it
has been possible to adopt, under existing conditions, in the case of children found to be suffering
from tuberculosis.
In the report on children out of school for long periods on account of ill-health (p. 49) it is
shown that 533 such children are registered as suffering from tuberculosis, viz., lungs, 377 cases;
glands, 68 cases; other organs, 88 cases; the total being 15 per cent. of the whole number so
excluded.