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within six months, as compared with 49.6 per cent, in 1914. This falling off is the result of the preoccupation
with other National interests of hospitals, doctors, parents and voluntary helpers. The
"leakage" is greatest in conditions requiring operative interference.
Co-operation
between
Maternity
Centres and
School
Medical
Service.
Closer co-operation has been established between the authorities of maternity centres and the
school medical service. In many instances arrangements have been made for the record cards of children
who have attended the maternity centres to be passed on to the Council when the children attend
the elementary schools. In two cases, the school treatment centre premises and equipment are also
used by the maternity centres for the treatment of the mothers and of children under school age. This
arrangement, in addition to being an economical one, has the further advantage that the centre becomes
fully known to the parents, and it enables more complete records to be kept of the children's medical
history. Similar schemes of co-operation are nearly completed at four other centres.
Registration
of attendances
at
Treatment
Centres.
In 1914, the Board of Education agreed to recogmse, under certain conditions, the attendances
of children at treatment centres as school attendances. In order to satisfy the requirements of the
Board in connection with the registration of these attendances, a large amount of work was undertaken
by the teachers and the officers at the treatment centres. In view of the relatively small amount
of grant received, compared with the administrative expenses, representations were made during the
early part of this year to the Board with the object of simplifying the procedure. As a result of
conferences between officers of the Board and of the Council, arrangements have now been made whereby
the teachers have been relieved of all clerical work in connection with the registration, and a considerable
saving in postage has been effected.
Government
grant.
ihe grant awarded by the Board of Education under Bart 1. of the Medical Grant .Regulations
for the year ending 31st March, 1917, amounted to £47,736 1s. 0d., and was again assessed at the
maximum rate, representing 50 per cent, of the Council's expenditure on medical inspection and
treatment and ancillary work. As regards the rate at which the grant has been assessed, the Board
direct attention to their letter of the 28th March, 1916. and state that the warning contained therein
represents the considered intention of the Board, and that they will not be prepared to continue to
pay grant at the maximum rate unless such improvements and extensions as they may deem to be necessary
are carried out when circumstances permit.
Open-air
schools.
The open-air schools at Birley House and Shooters Hill were both kept open throughout the
year. The Kensal House school for tuberculous children has been continued, and some of the play
ground classes were, as in the past, held in the public parks.
Special
schools.
In all, 5,422 children were examined with a view to admission to special schools ; of these. 2,813
were certified as suitable for admission, and the remainder were either returned to the elementary schools,
or found to be unsuitable for any of the Council's institutions. The results of the periodical re-examination
of children in the schools for the mentally and physically defective, are shown in the report.
Personal
Hygiene
scheme.
The Council's cleansing schemes have been in operation throughout the year There are now
24 stations, and at 20 of these treatment has been extended by the inclusion of scabies. 988,288
examinations of children were made, in 24,705 cases the children were found to be verminous ; 11,314
children were cleansed by the parents, and 13,391 children were cleansed by the Council and the borough
councils. 3,213 children, suffering from scabies, were given a total of 17,583 baths. This is a large
increase on the number shown last year, and the cause is attributed to infection by soldiers from the
front. Verminous children attending schools in outlying districts are now brought within the scope of
the scheme, and are conveyed to the cleansing stations by means of ambulances. In some instances,
moreover, borough councils are now giving special facilities for hot baths to be obtained by school
children and members of their families.
Infectious
diseases.
The year 1916 stands out as specially remarkable for diminished prevalence among school
children of infectious diseases as a whole. In the case of scarlet fever the figures are particularly
noteworthy; indeed, during two weeks in August, and again, in three weeks in December,
the scarlet fever cases notified in the whole of London descended below 100, being only about one-third,
or less than one-third, of the average for corresponding weeks of the last five years ; much more markedly
below the figures of the early years of notification ; and representing prevalence of the disease presumably
far below that of 50 years ago. This very exceptional behaviour of the figures merits careful examination
and on pp. 35-37, an attempt has been made to study some of the influences which may have been operative
in producing so striking a result. The effects of altered nomenclature, of climatic influence, and of
flea prevalence are referred to, and the question as to relationship of scarlet fever and diphtheria is
also considered. As regards flea prevalence it was, of course, realised 8 years ago, when the close
similarity of the seasonal curves of fleas and scarlet fever was first commented upon, that it was desirable
to ascertain whether the maximum for fleas did or did not ante-date that for scarlet fever. The records
show that it has done so each year. Moreover, study of the fluctuations in annual prevalence for the
eight years is now seen to yield a striking correspondence in the yearly variations of the flea and scarlet
fever curves.
The importance of the part played during the last half century by hospital isolation, in limiting
the mischief wrought by scarlet fever, is taken for granted—the discussion in detail of this influence
is far too large a question to enter upon here—but it is pointed out that it has been, indeed, a fortunate
circumstance that, during the year under review, the low level reached by scarlet fever has freed many
beds in the hospitals of the Metropolitan Asylums Board for use for other purposes.
Measles was for the most part at a low ebb, but showed signs of increasing in prevalence
particularly in South-East London, toward? the end of the year. The figures relating to notified cases
of Cerebro-spinal fever and poliomyelitis somewhat exceeded the average for the preceding 5 years, but
were lower than in 1915.