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Following-up and re-inspection of ailing children.
The work of following-up and securing treatment for ailing children is essentially the most
important branch of school medical work. In London this is entrusted to the care committee organisation.
Each school has a committee of voluntary workers who interview the parents and help them to carry out
the advice of the doctors. The number of these workers is 4,850; they are supported, guided and recruited
by a staff of 129 organisers. The work includes feeding of necessitous children and after-care. The
organisation is placed under the direction of a principal organiser, who is a half-time officer in both
the Public Health and the Education Departments, and while the organisers are allocated for financial
purposes to either department the organisation functions as one and the staff is in effect a pooled staff.
The organisation has been extended to the day continuation schools.
During 1921, including the entrants to day continuation schools, 294,552 children were examined
in detail at elementary schools ; 113,732 or 38.6 per cent, required treatment for one or more defects.
In addition 2,255 children were examined in detail at Special schools, and 40 6 per cent, were found
in need of treatment. 73,470 children were seen as urgent cases, of whom 26,425 required treatment,
thus 141,072 children were advised to have treatment.
The results of following-up are obtained from the returns of re-inspection, and a complete
system has been devised whereby each child referred to the care committee is re-inspected after a definite
interval. The first re-inspection takes place four to six months after the primary inspection. During 1921,
under this arrangement, 112,776 children were re-inspected; of these 452 per cent, were discharged
as satisfactorily dealt with. The remaining 54.8 per cent., who were still undergoing treatment or in
whose cases treatment had been neglected, were referred for further re-inspection. The second reinspection
takes place four to six months after the previous one. Special attention is drawn to neglected
cases, and every endeavour made to secure the parents' co-operation. In cases of difficulty a special
officer in the education officer's department assists the care committee. In serious cases where all
attempt at persuasion fails, the N.S.P.C.C. are informed and take action, in some cases involving prosecution.
Mr. Robt. J. Parr, the Director, states that during the year ended 31st March, 1922, of 484
cases involving 586 children referred to their medical branch, cases affecting 296 children had been dealt
with successfully, while those affecting 290 other children were still pending. 62,320 children were
submitted to second re-inspections, and 603 per cent, of the children were found to
be satisfactorily dealt with. Combining the results of the two inspections it is found
that 78'2 per cent, of the children coming for review during the year had been satisfactorily dealt with.
This result is an improvement on the previous year, and is the best that has hitherto been attained;
considering the constant growth of the work carried on, this result reflects great credit upon the efforts
of the voluntary workers. The growth in importance of the Council's provision for treatment is shown
by the fact that 73 per cent, of children treated receive their treatment under the Council's scheme,
while only 27 per cent, are able to obtain treatment by private practitioners or at hospitals not included
in the scheme.
Under the direction of Dr. Chaikin the twelve assistant medical officers working in the Eastern
division have carried out a concerted investigation into the incidence of rickets among school children.
10,000 children were examined, of whom 2,099 (21 per cent.) were found to show some evidence of
rickets. Of these 1,717 (17.17 per cent.) showed slight and 382 (3.82 per cent.) showed marked, signs
of the disease. The children were distributed throughout the age groups. 3,114 of the children were
those born in 1913 ; 1,196 of these were boys, and 393 were found rickety or 32.9 per cent.; of 1,372
girls 312 were rickety or 22.7 per cent. Thus the incidence is much higher on boys than on girls. 70 of
these boys, or 5.8 per cent., and 43 girls or 3.1 per cent., showed marked rickets. It is these marked
cases alone that would be recorded at ordinary routine inspections, and here again the incidence
is heavier on boys. The heavier incidence of course is a long established observation. Of 705 children
born in 1913, in whom the incidence of rickety manifestations in particular organs was investigated
and the results analysed, 90.63 per cent, showed rickety chests, 35.3 per cent, rickety crania, 109 per
cent, rickety long bones, 52'15 per cent, caries of the teeth, and 34.6 per cent, other defects of the teeth
(pitting of enamel, irregularity, etc.).
Incidence of
rickets.
inquiries showed that at least half the children who exhibited rickety signs had been poorest fed.
With regard to racial incidence, the schools investigated were divided between schools mainly Jewish
and schools mainly non-Jewish. The incidence of rickets in the former schools was considerably less
than in the latter.
Total examined. Slight rickets. Marked rickets. Total rickets.
I.—Non-Jewish schools 5,855 1,172 235 1,408
II.—Jewish schools 4,145 544 147 691
Thus while 24 per cent, of children in " non-Jewish " schools were found rickety only 16.6 per
cent, of children in " Jewish " schools were rickety. This classification is, however, rather misleading for
it by no means follows that all the children attending such schools are indeed Jewish or non-Jewish.
In fact where purely Jewish schools were taken the incidence of rickets was specially high (38.25 per
cent.). It appears that the above classification of schools is complicated by another factor. The first
set of schools (classed as non-Jewish) contained children in the main from poorer homes than in the
second set of schools, and family circumstances appear heavily to outweigh racial differences. The
school doctors considered carefully the question of breast-feeding, and it was a matter of surprise that
such a large proportion of the rickety children were breast-fed. These, they say, are cases of too prolonged
breast-feeding; irregular feeding and the health of the mother are contributory. There is still much
room for instruction of mothers on the correct feeding of infants, as much on the breast as otherwise.
The heavy incidcnce of rickets upon the walls of the chest, producing well-known deformities
is pointed out by the doctors. They associate this special incidence with the presence of adenoids to
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