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In regard to general personal cleanliness the conditions found show continuous improvement.
In fact from this point of view the state of the schools to-day contrasts in a marked degree with their
state say twenty years ago. In fact there is no comparison to be made. Intensive effort on the part of
school nurses (the London School Board appointed a nurse in 1902) and teachers has brought about a
veritable revolution, and whereas formerly children were found attending school in an indescribable
condition of uncleanliness, such children are now rarely met with, even in the worst neighbourhoods.
While the presence of body vermin, in children attending school, has been reduced to almost vanishing
proportions, the state of the hair in girl scholars is still a source of some concern. The figures for 1921
show unfortunately a slight set-back compared with those of 1920 although they still indicate much
improvement compared with those of former years.
Personal
hygiene
The explanation ot this falling on, following as it does a number ot years in which the hgures
showed a steady general improvement must be sought. At the outset it must be pointed out that all
cases where nits are found are placed in the second column, but the fact that 25 per cent, of girls of twelve
are placed in this category does not mean that such children are in a grossly verminous or even in an
infectious or possibly infectious condition. The results of a single accidental infection often cling to
the hair for months after all infection or possibility of infection has ceased, yet according to the London
standard, children presenting the slightest trace of vermin (and these form the vast majority of the 25
per cent.) are placed in this category. Still the persistence of the signs of past infection has its value in
the estimation of the general level of cleanliness attained.
There are five possible explanations of the rather disappointing figures for 1921. In the first place
it should be realised that a change in the method of dealing with girls was necessitated at the beginning
of the year. In previous years it was necessary, in order to comply with the provisions of the Children
Act, to cut the hair in order to effect a cleansing, and the original notices delivered to parents
drew attention to the possibihty that it might be necessary to cut the hair compulsorily if unsatisfactory
conditions persisted. That the fear of this occurring had a very potent effect upon the attitude of
careless parents there can be no doubt. During 1920 it was demonstrated that cutting the hair was not
necessary to efiect a cleansing in one operation, and as it might be held that the Council, therefore, no
longer had a legal right to have the hair of children compulsorily cut the notices and the practice were
both withdrawn. In the second place increasing economic stringency and distress may have had some
effect, as poverty and dirt from time immemorial have been close bedfellows. In the third place the
attention of the staff has been of late strenuously directed towards this condition, and it is probable
that fewer cases have been missed. In the fourth place, during 1921 some thousands of transmigrants
passed through London, and this may have been a factor in lowering the standard previously attained.
It is known that transmigrants kept under surveillance during their temporary residence in London
have been in a very verminous state. In the fifth place, from 1918 onwards, much additional work was
thrown upon the cleansing stations in connection with prevalence of scabies, and this led to considerable
interference with the efficiency of the work relating to pediculi. During the closing months of 1921
the pressure caused by scabies cases very materially lessened. In those months scarlet fever and diphtheria
were prevalent and this involved a certain number of exclusions from school with consequential
interference with the cleansing operations. When analysed in districts, it is found that it is the poorer
areas, or areas in which there is a particularly poor district included, which shew a lowered standard of
personal hygene amongst girls. while the better districts have continued to imnrove.

Dental
conditions.
The continued improvement of the teeth of the older children, as shown in this table, is very
gratifying. It is clearly correlated with the progress in dental supervision during school life which has
been so marked a feature in late years. As further dental centres have been opened more schools have
been brought under proper dental supervision, and it is perhaps a noteworthy achievement that ten per
cent, more boys and girls (8,000 children in London) now leave school during the year with sound teeth
than was the case eight years ago; especially as the condition of the teeth of entrant children shows
no corresponding improvement.
Chronic catarrhal conditions of the nose and throat are exceedingly common in the child population
of the county. Out of 217,333 children examined 35,784 or 16.5 per cent, were found to be so
suffering in one form or another. The majority of these were affected in only a minor degree, and special
advice to the mother on hygiene was alone necessary. 10,362 (4.8 per cent.) were referred for further
treatment for tonsils and adenoids. The number of children thus sent diminishes year by year, in 1920
the percentage was 55 per cent, and in 1919 was 61 per cent.
Tonsils and
adenoids.
Much discussion has taken place of late on the question of operative treatment for these ailments,
The fact that only one-fourth of the children who are found to have some degree of unhealthiness of the