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excess in rickety infants. As children grow older many of the signs of rickets disappear, but there is a
residuum. These children left with deformity indicate the special need for physical exercises and especially
breathing exercises in the schools.
The incidence of rickets on children born during the war and on those born previously was carefully
compared. There is distinctly a lower percentage of rickets in entrant children who were born
during the war (14.12 per cent, compared with 22.64 per cent, in children born in former years). This
confirms the findings as to the improved nutrition of the children which were made in these reports
during the war years. The figures were all the more remarkable inasmuch as it is in the entrant children
that the signs of rickets are always the more marked. The doctors in the concluding paragraph of their
report consider the directions in which effort should be made to counteract the evils which result in so
many children being found at school with evidences of the effects of infantile rickets. The chief things
they lay stress upon are improvement in home conditions, more open spaces, instruction of mothers
in infant care, safeguards for maternal health, and in school more physical exercises in special classes
and continued attention to the teeth which, in association with nasal obstruction, must be "treated
together to prepare the healthy mouth and throat essential for a healthy chest.
Dr. C. N. Atlee independently made observations upon 5,000 children in the Greenwich area.
While he attended only to the more marked manifestations, he also confirms the East End results, finding
considerably less rickets among the entrant infants than in the eight year-old group, and he
attributes this entirely to the full employment and good wages earned during the war.
Co-operation
between the
school
medical
service and
tuberculosis
officers.
in 1920 a scheme for co-operation between the school medical service and the tuberculosis officers
was drawn up. The following report from Dr. Chaikin, divisional medical officer in the eastern division,
illustrates the way in which the work is being carried out.
The scheme provides for the observation by the school doctors of the children of school age
nominated by tuberculosis officers. The periods of observation vary. They are either fixed by the
tuberculosis officers at the time of nomination, or are left to the discretion of the divisional medical officer
During the period stated the child does not attend the dispensary but is examined and re-examined at
intervals of not less than three months. The tuberculosis officer, on nomination, makes a clinical report
with recommendations. The latter refer to school attendance, nourishment and general treatment. The
district organiser of care committees is informed of every case so nominated.
Arrangements are made for examination by the school doctor. At the end of the period of observation
a report is sent to the tuberculosis officer and the child attends the dispensary. It is open to the
tuberculosis officer to re-nominate a case if he thinks fit. A child, who is under observation, may return
to the dispensary any time before the expiration of the period of observation, if treatment becomes
necessary through a change in condition. No child, however, returns to the dispensary under the
scheme without the knowledge of the School Medical Service, and without a report to the tuberculosis
officer. The scheme has worked very well administratively and provides a complete chain of observation.
The tuberculosis officers have been able to refer cases to the school doctor and thus to relieve the
dispensaries. Altogether 250 cliildren were nominated by the tuberculosis officers for observation by the
school doctors. Of these the largest number were from Poplar. 115 children are still under observation and
135 have been returned to the dispensaries after observation has been completed. The number of examinations
carried out in different cases varied from one to four. The usual number was two. In 13 cases
children relapsed and were sent back to the dispensaries before the observation period had been completed.
549 appointments were made for examination, and the actual number of examinations made was 426.
Children were re-examined by the school doctors at periods varying from three to twelve months. Most
children were seen at intervals of three months and many at six months. Very close co-operation with the
tuberculosis officers has been secured and in every respect the scheme has worked very well and
smoothly.
Employment of school children.
The introduction in July, 1921, of the new by-laws in London regulating the employment of
children has placed upon the school medical service additional duties, inasmuch as no child of school
age may now be engaged for wage-earning employment unless a certificate of health signed by the school
medical officer has been obtained. The number of children dealt with between July and December
inclusive was 4,649, of whom only 152 were girls. In 37 cases, medical certificates were not given for
the following reasons :—heart disease, 9: tuberculosis, 4; dyspnoea on exertion, 2 ; debility, 4 ;
defective vision, 1; bronchitis, 1; otorrhcea, 1; hernia, 1; hip disease, 1; rheumatism, 1; tonsillitis, 1;
Graves' disease, 1 ; under age and other causes, 8.
In addition, 154 conditional certificates were given. The conditions stipulated for comprised
necessary treatment, special feeding, limitations of work, special care, etc. The number of children
seen in each district was : North-eastern, 869 ; North-western, 1,252; Eastern, 123; South-eastern,
1,003; South-western, 1,402. The small number of children submitted for examination in the East
End is rather surprising. The number of examinations exceeded the number of children as many
certificates were granted on condition of periodical re-examination.
Particulars were given in the last annual report in regard to the medical supervision of children
employed in public entertainments. This supervision has been continued, and entails considerable
work, inasmuch as the children must be re-examined at intervals of three months. A large number
were found in the spring months to be suffering from scabies, and this was found to extend to children
licensed by education authorities in the country and examined on passing through London. It appears
that as troupes move about the country, they regularly occupy lodgings vacated by previous troupes,
and no doubt in this way a large proportion of children at that time employed by touring companies
contracted the disease. Apart from this trouble, it has been noticed that the condition of children
employed in entertainments who come from elementary schools has greatly improved since the coming
into force of the Order.