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21
treatment was still required. The delay in obtaining treatment is to be attributed partly to the engagement
of care committee workers in other directions, partly to the decreased facilities at hospitals not
included in the Council's arrangements, and in some degTee to the employment of mothers on war work.
At six centres arrangements have been made under which the same premises are used for the
purposes of school treatment centres and infant welfare centres, to the mutual benefit of the Council
and the authorities of the infant welfare centres. Further schemes of co-operation are under
consideration.
Co-operatioa
with
Infant
Welfare
Centres.
The grant awarded by the Board of Education under Part I. of the Medical Grant Regulations
for the year ending 31st March, 1918, amounted to £49,082 3s. 4d., 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 during the previous year. Under Part II. £754 10s. was awarded in respect of the
open-air schools at Kensal House, Birley House and Shooter's Hill, and under Part III. £599 4s. 5d.
was allowed for physical education, both amounts being calculated at the maximum rate.
GoTernment
grant.
The open-air schools at Birley House and Shooter's Hill were both continued; formerly they
were hold throughout the year, but in 1917 they were closed for the Christmas holidays. 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.
Open-air
schools.
In all 5,566 examinations were conductcd with a view to admission to special schools. Of these
2,768 were certified as suitable for admission, and the remainder were either returned to elementary
schools or found to be unsuitable for any of the Council's institutions. The results of the periodical
examination of children in the schools for the mentally and physically defective are shown in the
roport (p. 39).
Special
schools.
The report contains results of analysis of samples of meals supplied to the schools, and attention
has been particularly directed to the question of the adequacy and quality of the food supplied. Save
as regards milk, as already mentioned above, there has been no departure from the accepted standard.
Supervision
of dietaries,
etc.
The Council s cleansing schemes have been amended so as to permit of the compulsory stage
being reached at an earlier date. There are now 25 cleansing stations, including one opened in January
of this year (1918) at the camp school, Wellington-street, Deptford; at 21 of these treatment has been
extended by the inclusion of scabies. 798,643 examinations of children were made, and in 19,506 cases
the children were found to be verminous, 8,506 children were cleansed by the parents, and 11,000
children were cleansed by the Council and the borough councils. 6,940 children suffering from scabies
were given in all 30,317 baths. This is a large increase on the number shown last, year, and the cause
is no doubt infection introduced into the homes, mainly from abroad. Attention is drawn to the closer
co-operation between the Council and the hospitals and treatment centres for the following-up of the
cases.
Personal
hygiene,
The year was especially notable for the extent to which attention was arrested by and concentrated
upon the problems arising out of verminous conditions. The great improvement in this respect
brought about since 1870 and particularly during the last thirty years is appreciated by everyone who
has had experience of London children extending over that period, but the campaign against vermin
has. unfortunately, until quite recently not excited much general enthusiasm, and those whose immediate
duty it has been to endeavour to combat the prevailing indifference with regard to cleanliness,
more particularly the Council's nurses, have often had a very difficult and at all times a much criticised
task to perform. It is now, however, becoming realised that the banishment of plague from Europe
in the seventeenth century was in all probability closely bound up with altered conditions affecting
prevalence of one or other species of vermin, and the practical extinction of typhus and relapsing fever
in this country, dating from nearly 50 years ago, diseases until then regarded as " almost necessary
incidents of existence " in the oase of poor people, stands in close relationship with general improvement
in the condition of the population as regards infection with body lice. This has been brought about in
part by action such as that taken under the Baths and Wash-houses Act (1846) with regard to public
provision of conveniences for washing, and in part by the influence exerted by isolation and cleansing
of infected persons in hospitals.
It is well known that infestation by body vermin was not uncommonly experienced, even in the
higher ranks of society, until within a century or two ago, and during the. past 70 or 80 years, even in
carefully tended homes, the invasion of houses by bugs was a, frequent source of annoyance ; the
published letters of Jane Welsh Carlyle bear witness to this and enable readers of to-day to appreciate
the serious importance assumed by "small beings," as Mazzini termed them, in domestic life in Chelsea
less than a century ago. In many poor homes the problem is still a very serious one.
It was noted more than 500 years ago by John de Trevisa that in this country the flea "Wexeth
slowe and faylcth in colde time and in somer tyme it wexeth quiver and swifte and spareth not kynges."
Since 1909 the seasonal prevalence of fleas throughout each year has been carefully studied in London
and from 1913 onwards the statistical records have been based on examination of school children, and
the resulting flea curves have been published in successive annual reports. The amount of discomfort
caused by flea-bites in the child population has incidentally been revealed, but it is not possible to allow
the question to rest at this point. Of late years study of plague and of the part played by insect parasites
in its spread has greatly emphasised in India the importance to be attached to fleas, and it may
be that it is now necessary to look nearer home. Reference is made on page 15 to the results of the
enquiries carried out during the last nine years in London with regard to the relationship between the
flea curve and the ourve of scarlet fever, and the case in favour of a flea hypothesis of causation of
scarlet fever is, it may now be claimed, one which calls for close examination. Dr. Russell, in his recently
published monograph on the flea, points out that, contrary to the general belief, monkeys have no
Verminous
conditions
and infectious
disease.