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24
Supervision
of dietaries,
etc.
As in 1917, the number of children receiving free meals remained phenomenally low, but the
presence of food restrictions was becoming increasingly felt. In last year's report the unprecedentedly
unsatisfactory results of analysis of milk supplied to necessitous school children were referred to.
Doubtless in part as the outcome of the action taken, improvement was noted in the latter part of 1918.
Followingup.
The following-up difficulty, in cases referred tor medical treatment by the school doctors,
Dwing to the continued shortage of voluntary care committee workers, became especially acute in 1918.
rhe help of school nurses, in selected schools, under the arrangement adopted at the end of 1917, was
continued throughout 1918 with successful results.
Personal
hygiene.
The growing sense ot the need tor securing an improved standard of cleanliness among school
children, was further strengthened and developed during 1918. Various influences contributed to this—
the broadening of the views held as regards safeguarding the health of children, the increasing appreciation
of the part played by verminous conditions in the dissemination of disease, the clear evidence
of the spread of scabies by soldiers returning from the front—these factors were all operative. The
lessons learnt were, however, especially borne in upon the minds of the parents and relations of the
thousands of young men who became verminous, and suffered the attendant discomforts and
disabilities, despite all practicable effort on their own part, owing to the stern exigencies of life in the
trenches. There has resulted from all this a marked change in the point of view with regard to vermin.
For many years past there had been unwillingness on the part of many people, even to countenance
reference to the subject and certainly to face the obvious facts, with a resulting disposition on the part
of parents of the poorest children either to accept infestation as inevitable, or at any rate, to ignore or
even resent, the proffer of the facilities provided by the Council. The findings of the doctor or nurse
were again and again called in question, the advice given with a view to remedying the conditions found
vas not welcomed, and when the procedure sanctioned by law was invoked, the demonstration of nits
was looked upon in the light of an insult, the cutting of hair necessary in neglected cases was resisted
as a violation of the liberty of the subject, and the Council's nurses were not infrequently subjected to
actual ill-treatment. The scheme of procedure originally adopted was tentative and hesitating, but
despite this fact, it was very difficult in the early days to secure convictions even in the most extreme
cases of neglect. By the adoption of persuasion and of conciliatory measures and by the exercise of
great patience, steady improvement has been brought about, and the cleansing scheme has from time
to time been amended with a view to expediting the procedure. There is now general agreement as to
the necessity for taking prompt and effective action in bad cases, and the difficulties in securing enforcement
of statutory notices have materially lessened during the past three or four years. In the course of
1918 valuable help was given to the Council by Mr. Bacot, F.E.S., Entomologist to the Lister Institute ;
further modifications in the cleansing scheme are, partly at his instance, again being made, and Mr. Bacot
has prepared a memorandum which is being circulated by the Council for the information of teachers and
parents. In the following report (p. 35) reference is made to an attempt to promote larger use by school
children of the public baths of London. It is a striking fact that at the present time these baths are
not used up to anything approaching their maximum capacity. The existing provision no doubt
needs further supplementing, but even as it stands, if fully used throughout the day as well as in the
evening, it should be capable of giving a warm bath to every member of the population who would be
likely to require it, say once a month. The actual number of warm baths given in recent years has
only been about 4½ millions, the 3,300 baths being thus used on an average only some four times a day
and the number of these baths taken by each member of the London population being thus on the
average only one per annum.
There are now 25 cleansing stations, and it is hoped that two additional stations will be opened
during the year . At 22 of the stations arrangements have been made for children suffering from scabies
to attend for baths and sterilisation of clothing In all, 516,566 examinations of children were made,
and in 13,237 cases the children were found to be verminous, 4,912 children were cleansed by the parents,
8,325 were cleansed at the cleansing stations and 9,624 children suffering from scabies were also given
baths. The total number of cleansings at the stations was 95,003.
Early in the year an investigation was made by medical officers of the Board of Education into
the working of the Council's arrangements for medical inspection and treatment. The results of their
inquiries were communicated to the Council in a letter dated 27th March, 1918. This letter and the subsequent
communications between the Council and the Board raised many important questions,
especially in regard to the "following-up" of children requiring medical treatment. The whole
correspondence is set out on pp. 36—43.
Epidemic
diseases.
In 1917, two small localised outbreaks of dysentery, mainly affecting children, were reported one
in north and one in north-west London. No further development of dysentery prevalence was noted in
the general population in 1918 ; both this disease and other diseases associated with war and privation
were, however, encountered in certain institutions in London and in other parts of the country. Smallpox
just obtained a footing in London on more than one occasion, and in connection with these occurrences,
attempts were made to protect, by means of vaccination, children who might possibly have been in
contact with sufferers from the disease. This offer of vaccination was, as a rule, gladly accepted by the
parents and no cases of conscientious objection were met with.
Reference is made on p. 44 to the prevalences of influenza occurring during the year in relation
to their effect upon the schools. The mortality during the prevalence of November and December, in
the population generally, was phenomenally high and there can be little doubt that the wholly exceptional
conditions prevailing in the great centres of civilisation were contributory to this. In last year's
report the effects in promoting spread of measles and scarlet fever of crowding in underground places