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66
Observations
by Dr. Boome
on the
weekly curve
of efficiency.
over the age of 12, in order to eliminate the effect of puberty, which results in disturbances
of the thyroid gland, especially in girls.
34 of 895 boys examined were found with goitre and 43 out of 944 girls. Even
before puberty, therefore, there is a slightly higher percentage of girls affected (4.5
per cent. as compared with 3.8 per cent. in boys).
The total of 77 out of 1,839 children examined is a higher incidence of thyroid
enlargement than was expected. 21 of these children were apparently normal and
healthy otherwise, but the remaining 56 were abnormal, no less than 10 were
mentally defective, and 4 were congenitally deaf, 1 had congenital heart disease,
1 congenital cataract and 3 were epileptic. The comparatively large number with
serious congenital defect is very striking.
Dr. Atlee is of opinion that goitre has increased latterly; one of the normal
children with goitre had recently lived for eight months in Derbyshire, where goitre is
so common that the common name in England for the condition is "Derbyshire
neck." In the latter county the cause is held to be the character of the water
supply. Many observers have thought that disturbances of the thyroid gland
became much more frequent during the war, and it is thought by some to be a
concomitant or effect of anxiety neurosis. Further statistical enquiries into the
incidence of goitre seem highly desirable.
Some thirty years ago Professor Leo Burgerstein worked out the fluctuations
of the manifestations of fatigue during a lesson of a single hour. In a series of
observations recorded with Verdin's Spirometer on classes of boys by Dr. E. J.
Boome, it was noticed that there appeared to be differences only to be explained by
assuming change of vital capacity from hour to hour during the day, and especially
from day to day during the week. At Dr. Boome's suggestion Mr. W. C. Barham
undertook to make regular observations upon Class I. at Vauxhall Street Boys
School. The apparatus used was a U-tube of mercury with a dial arrangement
magnifying the readings ten times. The boys were required to maintain by lung
pressure a column of 25 millimetres of mercury for as long a period as possible.
Observations were taken throughout the day, every day in the week. In this way
the working curve of the day and of the week was obtained.
The results show that Mondays and Fridays are the days upon which the boys
are at their lowest pitch educationally and physically. During the week from
Monday until Thursday there is a gradual improvement, the highest efficiency
being recorded at mid-day on Thursday. Each day the maximum efficiency is
reached in the readings at 12 noon and 2 p.m. Thus there appears to be a daily
curve of efficiency reaching its maximum at mid-day, and a weekly curve reaching
its maximum on Thursday mid-day. These results have a bearing not only upon
the arrangement of school work during the daily time-table, but also upon the
weekly scheme of work.
Following-up and re-inspections.
All children found at medical inspections to need treatment or further observation
are re-inspected in six months' time, and, if necessary, again in a further six
months. Re-inspections, therefore, partially bridge the intervals between the
three comprehensive age-group inspections. 178,964 children came up for review
during 1922; 112,974 children for primary re-inspection during the year, and 45.2
per cent. were discharged as cured and not requiring further observation. The
remainder were marked for a second re-inspection ; 65,990 children were presented
for second re-inspection, and of these 59.3 per cent. were discharged.
Combining the results of first and second re-inspections, it is found that 77.7
per cent. of the children had been satisfactorily dealt with within a year after the
detection of their defects. The corresponding figure for 1921 was 78.2 per cent.,
the highest ever obtained. In view of the difficulties experienced in following-up
during the past year, which are elsewhere commented upon, the result may be looked
upon as very satisfactory.