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29
liness, the possible effect in some cases of the removal of apprehension on the part of the girls and their
mothers lest the hair might be cut, and the prevalence of unemployment with associated deterioration
in home conditions in the poorest boroughs.
On a broad view, as Dr. Thomas says, it is clear that the efforts of nurses and teachers have
brought about a veritable revolution, for children manifesting gross conditions of uncleanliness are now
rarely met with, even in the worst neighbourhoods.
The behaviour of epidemic diseases during 1921 particularly deserves study. The dry hot summer
favoured the spread and fatality of summer diarrhœa ; in December a prevalence of influenza was noted
in the schools and elsewhere ; but the most striking phenomenon of all was the development of a marked
wave of prevalence of the epidemic throat maladies, scarlet fever and diphtheria, which reached its
height in October and November. The altered behaviour in the last quarter of a century, as compared
with an earlier period, of these two epidemic diseases especially calls for comment. Seventy or eighty
years ago in the fifties, sixties and seventies the waves of throat epidemics swelled to their successive
crests at intervals of some 5 or 6 years, and in the years of maximum mortality considerably more than
1,000 deaths per million of the population of the country were recorded from scarlet fever and diphtheria
together. In the last twenty-five years the following changes have come about—(a) the interval between
the crests has sensibly lengthened to 7, and on the last occasion to 8 years ; (b) there has been an increasing
tendency (emphasized at the crests of the seven or eight year waves), for the proportion of cases
described as diphtheria to grow as compared with the cases described as scarlet fever ; (c) but especially
significant is the remarkable decline in deaths from these throat epidemics, and while the fall in the
mortality rate is greater in scarlet fever than in diphtheria the decline in case-mortality is fairly equally
marked in both. Instead of more than 1,000 deaths per million of population the death rates now in the
worst years are not one-tenth of those of 70 or 80 years ago.
It is instructive, therefore, to look back sixty years and note that the London epidemiologists of
that day had already probed to the root of the matter. Reference was made four years ago (Annual
Report 1918, p. 47) to Mr. J. Netten Radcliffe's paper in the Epidemiological Transactions of 1864-5,
p. 262. He spoke of the scarlatinal fields which were the foci of infection in the crowded courts of great
towns, and he urged that if cases of the disease could be weeded out of the denser masses of population
as they occur, it would be to the incalculable gain of the people. This weeding out process had commenced
on a small scale in Mr. Radcliffe's time ; it was steadily proceeded with until, in the early nineties,
nearly half the cases of scarlet fever occurring in London were being removed to the Metropolitan Asylums
Board Hospitals ; further progress continued and in the recent epidemic over 90 per cent, of the cases of
scarlet fever and nearly all the cases of diphtheria were isolated in the Metropolitan Asylums Board
Hospitals.
Special interest, however, attaches, so far as 1921 is concerned, to the fact that the combined
waves of prevalence rose above the height attained in the preceding year. In the report for 1920 the
possibility of such an occurrence was considered, and suggested explanations of the phenomenon are
examined on p. 43 of the present report.
With regard to other diseases incidental to school life measles was fortunately comparatively
quiescent. There was a marked rise in the prevalence of whooping cough, the numbers of cases of this
disease during the year exceeding by upwards of 1,200 those recorded for measles, a most unusual occurrence.
Mumps and chickenpox were considerably more prevalent than usual. There was a welcome
reduction in the number of scabies cases due no doubt partly to the improved facilities for treatment
provided by the Council, and to the cessation of introduction of the disease by returning soldiers.
As regards ringworm there was a noticeable reduction in the number of cases reported during 1921 as
compared with the preceding year.
Infectious
diseases.
Special references are made on pp. 50—52 to causes of deafness, mental deficiency and mental tests
of normal children, encephalitis lethargica, and a comparison of the offences committed by normal and
defective children.
The results of medical inspection.
Special
schools.
Routine inspections were arranged of all children in the three age-groups prescribed by the Board
of Education, viz., entrants, children aged eight and children aged twelve. The numbers actually inspected
were 41,304 entrant boys, 40,398 entrant girls, 33,494 boys and 33,530 girls at age eight, and
34,587 and 34,020 girls at age twelve, a total of 217,333 compared with 208,924 in the previous year.
At these ages also a corresponding inspection was made of 2,255 children in the special schools.
Number of
children
inspected.
39,270 children outside the age groups were presented to the school doctors for examination as
special cases and 34,302 children as general cases i.e., in the course of general examinations for specific
purposes, such as the investigation of outbreaks of infectious disease or in the course of selection of children
for open air schools, camp schools and the like.
Special
schools.
00,687 of the children in the age groups were found suffering from ailments for which treatment
was considered necessary or 39.4per cent., compared with 39.6 per cent, in 1920, 42.6 per cent, in 1919,
and 44 per cent., in 1918. Last year's improvement has therefore been maintained. In addition 26,425
children were referred for treatment from snecial insnections.
Number of
ailing
children.
The attendance of parents at the examinations of entrant children were especially good amounting
to over 80 per cent, of the cases. Less interest is shown, however, by the parents in the inspections of
older children especially of boys. The percentage of parents attending at the examinations of 12 yearold
boys was 40.3 and of 12 year-old girls 51.8.
The presence of the parent at the inspection is of great importance and although the good attendance
at the examinations of infants is especially gratifying, and renders these examinations very valuable,
it would be a great advantage if more parents attended at the inspections of older children, amongst
whom many defects are found.
Attendance
of parents.