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159
Report of the County Medical Officer—Education.
a bdominal exercises (involving lying upon the floor in the absence of a form provided for the purpose) is
pointed out by the school doctors. In some of the classes such exercises were included. In others the
doctors deplored their absence. The individual cases where improvement is noted to have occurred
include postural spinal defects, defects in breathing including mouth breathing and contracted chests,
muscular weakness and defective cardiac tone. One case of definite heart disease, included in the class
at the Chaucer school, was found by Dr. Boome to have greatly improved by the carefully graduated
exercises administered, although in the majority of cases the doctors excluded from the classes cases of
valvular lesion of the heart.
General improvement of the children's physical condition is noted by all the doctors; the average
increase in chest measurement and in chest expansion being satisfactory, and in some classes surprising.
Thus, at Winchester Street, the 23 boys in the special class showed an average expansion of the
chest of 1¾ inches in July, but in January this had increased to 2½ inches; the average chest expansion of
normal boys in the school of the same age at the latter date was 2½ inches. The boys, therefore, who were
selected as below the normal in physique had at the end of 6 months not only caught up but even advanced,
beyond the average shown by their fellows, in chest expansion. In many classes an increase in mental
capacity was reported in the children as their physical condition improved.
It is clear that such remedial classes carried out in the elementary schools are capable of producing
exceedingly satisfactory results and deserve a permanent place in the Council's arrangements for the
physical care of children. If the full benefits are to be attained, however, attention is necessary to the
clothing worn by the children during the exercises, and the introduction is advisable of certain exercises
not included in the ordinary syllabus, such as abdominal exercises generally, for which the provision of a
form is advisable, and crawling exercises. While postural spinal defects have almost invariably been
cured or greatly improved in these classes, in the graver conditions where spinal deformities have
become fixed no improvement has resulted nor was it expected that improvement would take place.
A report was recently presented to the children's care (Central) Sub-Committee upon the question
of the Council making arrangements for the treatment of cases of spinal curvature generally, and
particularly with regard to the Council making a grant towards the cost of remedial exercises already
being carried out at the Deptford Health Centre. Upon enquiry it was found that, although the
methods used at the Deptford Health Centre are excellent and the results good, yet the cost per child is
high. Thus the maximum number of cases it is possible to treat at the centre per annum is 60, while the
cost of treatment per annum is probably £150 to £180. The main reason for this high cost per case is
the fact that the children have to attend for long periods before they are discharged as cured. On an
average each child attends 105 times spread over a period of 35 weeks. Much of this time, however, is
spent in general exercises, each patient requiring special individual exercises only for one or at most two
months, i.e., 24 attendances. If the centre were linked up with other agencies much of the time and
expense could be saved and more than this the knowledge and experience of those engaged in the work
could be made to react with great benefit upon the entire scheme for the provision of physical
exercises in the schools.
Treatment of
cases of
spinal
curvature
With the arrangements made it should be possible that the general exercises required by the
children under treatment should be given in special classes in the ordinary schools. The trained
gymnast at the centre should visit the special classes in the ordinary schools and in this way her special
knowledge would be at the disposal of the teachers of the special class; the congestion at the centre
would be relieved, more cases could be treated and the cost per case considerably reduced. Arrangements
should also be made for the Treatment Centre to be linked up with the Orthopædic Department
of a great hospital in order that cases requiring individual apparatus or operative treatment could be
drafted to the latter, and vice versâ, cases at the hospital which had reached the stage of requiring
individual exercises only would be transferred to the treatment centre.
With regard to the application of physical exercises to individual children the following scheme
would apply:—
Normal child General physical classes in school.
Abnormal child examined by school doctor and
(a) Requiring special attention in perform- Special class in school.
ance of general exercises.
(b) Requiring individual exercises. Treatment centre or exercise department of
hospital
(c) Requiring individual apparatus or opera- Orthopaedic department of hospital.
tive treatment.
These three divisions could then be linked together in such a way that children can be transferred
from one to the other as the needs of each particular case demand. It would be necessary to
have the Board of Education's sanction to treating these classes as educational courses and allowing the
attendances to count for grant as in the case of visits to domestic economy and manual training classes.
The linking up of the arrangements for remedial exercises with the schools in the foregoing manner
would provide a means whereby the experience gained in the intensive study of individual children at the
Orthopædic Department of the great hospitals at one end would influence the general application of
physical exercises to the whole of the school children through the medium of ordinary class drill at the
other. At present there is want of cohesion between all the activities dealing with physical exercises in
London and there is a considerable body of knowledge in existence which is not being fully utilised. A
scheme such as is sketched above would enable a plan to be evolved whereby the Council's inspectors and
organisers of physical exercises, the medical officers of the public health department, the orthopaedic
surgeons and trained gymnasts at hospitals and treatment centres, the teachers in the schools and the