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was necessary, therefore, to establish a standard minimum of efficiency. The test adopted was that a
dinner for eight children should supply 200 grammes of protein and that the heat giving capacity should
be not less than 6,000 calories. Of 48 samples of the meals supplied, 45 gave satisfactory results on
chemical examination, while three were deficient in nutritive materials and fat. Of the 200 samples of
milk taken, 48 (nearly 22 per cent.) were found to be unsatisfactory, and the medical officer of health of
the borough in which the milk had been purchased was supplied with information for the purpose of
taking samples in accordance with the Sale of Foods and Drugs Act. In one case a fine of £10 was
inflicted on each of two summonses under this Act.
Medical
inspection of
individual
children.
When children during the routine inspections of the age groups are discovered to be undernourished
the school doctors make recommendations to the care committees with regard to feeding,
and in the small proportion of cases in which the assessment 4 is placed opposite the nutrition record
a very careful system of following up has been carried out, and the physical measurements of the
children taken.
About 10 per cent. of children inspected in the age groups are found subnormal as regards
nutrition, and from this it may fairly be inferred that 10 per cent. of all children are subnormal
Amongst children on the necessitous list, medical inspection has shown that about half are ill-nourished
and half well-nourished. Of the ill-nourished children on the necessitous list a certain percentage were
referred to the care committees by the school doctors. Again there are always some children on the
feeding list about whom care committees are in doubt, and concerning whom they welcome a medical
opinion.
In a letter from the Board of Education (9.8.15) relative to the visits of their inspectors to the
Council's dining centres, the following statement was made :—
" The association of the School Medical Service with the work of providing meals, especially
as regards the supervision of dietary, analysis of meals, and investigations of malnutrition, seems
to be close and thorough, and should have valuable results. The Council are no doubt aware
that the Board attach great importance to this co-operation."
Children out of school for long periods.
The arrangement has continued whereby the attendance branch of flie education officer's department
submits each month to the school medical officer, medical certificates concerning all children out
of school for a period of three months on account of ill-health, but it has not been possible to keep up
beyond September last the card index of the cases. The number of new cases notified during the period
from January to September was 4,239, but more than one return has been made in the case of many
of the children. Altogether 8,713 returns have been made. In 1,878 cases medical certificates were
supplied.
The rheumatic group of diseases forms the highest proportion—over 25 per cent, of the total
—among the causes that produce protracted absences from school. Next conies tuberculosis in various
forms with nearly 15 per cent.
The action taken in cases in which further following-up was considered advisable was as follows:—
Total number of new cases, 4,239; referred for examination by school doctor, 591; sent to divisional
medical officer for information, 51; referred to attendance officer for further enquiry, 45; examined
for special school, 139 (M.D., 3; P.D., 112; open-air school, 24); referred to ophthalmologist, 15;
placed on epileptic register, 78; referred to school care committees, 139.
The results of the examination by the Council's medical staff in 497 cases are as follows:—
Fit to return to school, 308; unfit to return to school, 143; physically defective school, 43; further
examination, 3. This section of the work of the School Medical Department has particularly suffered
owing to the shortage of clerical assistance. The work, however, being of great importance, is continued
on modified lines. All cases of tuberculosis and epilepsy are still being registered, and apparently
unsatisfactory or doubtful conditions are being followed up, especially such conditions as ringworm,
scabies and minor ailments.
Tuberculosis.
The work of the Council in respect of the treatment of persons suffering from tuberculosis during
1915, has been confined mainly to the development of the organisation for giving effect to the commitments
of the Council prior to the commencement of war. Beyond taking the requisite number of beds
to cope with the demands arising from the working of borough dispensary schemes and from the need for
treatment revealed by school medical inspection, the only matters which call for special attention in
existing circumstances are (1) the approval by the Council on 15th June, 1915, of a model scheme for
the institution, in connection with dispensaries, of care committees representing all the local organisations
engaged in the relief of sufferers, and (2) the decision of the Council that when dealing with children, it
would require all parents to make a small contribution roughly representing the cost of keeping the
chidren at home.
The model tuberculosis care committee scheme will be dealt with in the General Section (Part I.)
of next year's report. Here it is sufficient to mention that interim committees are being constituted,
including officials of the London County Council and Borough Councils, and as many as possible of the
personnel provided for in the model scheme. The assessment of the amounts to be paid by parents in
part payment of the cost of the treatment of their children commenced in November, 1915.