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25
Speech
detects.
The percentage of stammerers remained unchanged (.25 per cent.), the incidence as usual being
much heavier upon boys (472 boys to 163 girls). Other speech defects showed a slight reduction, .54 per
cent. compared with .69 per cent. previously.
Heart
disease
The number of children with heart disease found at routine medical inspections is tending to
increase. Thus, 31 per cent of the children were recorded as having defect of the heart in 1915, as
compared with 2.7 per cent. in 1914 and 2.2 per cent. in 1913. It is to be noted, however, that the more
severe cases of heart disease are sent to physically defective schools, but there has been a growing tendency
during the last two or three years to allow well compensated cases of heart disease to remain in the
ordinary schools, partly owing to the reliance that is now placed upon the care organisation in the ordinary
schools, and partly because of pressure of accommodation in the special schools.
Anaemia.
The amount of severe anæmia detected is practically stationary, 2.79 per cent. of the children
being recorded as anaemic compared with 2.82 per cent. previously. Entrant boys are more anæmic than
entrant girls, but while the boys steadily improve during school life, the girls do not, so that at older
ages the incidence is heavier upon the girls.
Disease of
lungs.
Lung troubles other than tuberculosis were found in 3.9 per cent. of the children; by far the
highest percentages being amongst the entrant infants, who so often have bronchitis associated with
rickets.
D seases of
the nervous,
system.
The percentage of children found with nervous disease was 1.07 compared with 0.99 the previous
year,
Leaver girls show signs of nervous trouble to a much higher degree than do leaver boys.
Tuberculosis.
Only 498 children were found to be suffering from phthisis (0.9 per cent.), a distinct drop as
compared with previous years, Other tuberculous disease was found in 642, or 0.25 per cent., practically
the same figure as that formerly found. The smaller number of cases of phthisis must be connected with
the provision for treatment for children suffering from the disease, of whom a large number were sent
away to sanatoria during the year, and a still larger number were excluded from school at the request of
tuberculosis officers of the dispensaries.
Rickets.
It is necessary here to point out that although only 498 children were found suffering from phthisis
at routine inspections, 513 sufferers from the disease were detected amongst children at special or urgent
examinations, or more than 1 per cent. of those brought to the notice of the school doctors in this way.
5,082 children were found suffering from rickets, l.97 per cent., as compared with 1.72 per cent.
last year, and 2.l per cent. in 1913. The chief incidence is upon entrants, and at each age boys are found
to be affected twice as frequently as girls. The disease is usually recognised about the sixth month,
and produces its main effects in the first two years of life.
Investigation
of rickets by
Dr. Lawsou
Dick.
Dr. Lawson Dick examined upwards of 1,000 children in East London, of whom about 800 were
Jewish. The well-nourished, well-clad Jewish children are, in spite of the care bestowed upon them by
the parents, not infrequently rickety. As regards feeding, 81 4 per cent. were breast-fed. Among 300
non-Jewish children at the Hackney Centre for Mothers 57 per cent. were breast-fed entirely and 20 per
cent. only partially owing to the mother going out to work. As the majority of these poor mothers
nursed their children, the prevalence of rickets is not mainly due to want of breast-feeding. Only 20 per
cent. of the 1,000 children were entirely free from signs of rickets, while 72.5 per cent. of breast-fed, and
87 per cent. of bottle-fed babies, present evident signs. In only one-fifth of these rickety children
was the nutritional condition poor. The most prominent signs are faults in the calcium nutrition of
the teeth and skeleton. Beading of the ribs, chest deformities and thickenings of the skull occurred in
70 per cent. When the teeth are examined, caries is very commonly found, and hypoplasia of the enamel
is frequent; this condition exhibits itself in stunted growth of certain teeth with defective formation of
the enamel varying from deficiency over the whole crown to irregular coating producing a honeycombed,
or a merely pitted appearance. This condition Dr. Dick considers almost pathognomic. Hypoplasia
due to inherited syphilis is exceedingly rare, whilst that due to rickets is very common in school children.
The estimation of the frequency of hypoplasia is interfered with by the prevalence of caries. Of
586 rickety cases, 42 per cent. had normal teeth, whilst 58 per cent. were defective; 38 per cent. were
carious, and 20 per cent. showed well marked hypoplasia. In cases with caries the lower first molars
were affected in about 80 per cent.
Tonsillar enlargement was excessive, while catarrhal conditions, especially bronchial catarrh,
were present in about 18 per cent. Physiologically the rickety child is essentially a backward child ;
in 48 per cent., walking or speech or both were delayed until at least 18 months old. Defective speech,
especially lalling, is frequent. The mental condition in early school life is one of dulness, with an
apparent awakening about six or seven years of age, but even then the child frequently remains a year
or two behind the average. The 800 rickety children were assessed as 11 per cent. bright, 64 per cent.
average, and 25 per cent. backward.
The essential social factors causing rickets apparently are defective housing and overcrowding,
with absence of sunlight, want of ventilation and confinement, associated with insufficient exercise ; if,
in addition, there is deficiency in food, especially in the nitrogenous elements, the conditions are
aggravated.
Deformities.
The problem of prevention is that of proper distribution of population, town-planning, cheap
travelling facilities, and proper feeding in quality and amount. Inasmuch as the chief defects occur in
the first two years of life, it is important to have the child under medical supervision as soon as possible.
5,320 children were found with deformities presumably due to other causes than rickets or tuberculosis.
This is a higher percentage than previously noted, viz., 2.06, as compared with 1.88. There
was a decrease in the amount of deformity amongst the boys, and the difference is entirely due to a
larger number of leaver girls reported with spinal curvature, 2,103 girls being found with deformities at
this age, compared with 1,022 during the previous year.
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