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glands and under- nourishment. The greater neglect of attention to the teeth in
boys than in girls is the reason for the especial incidence of ill-health in this group,
although it may be that as boys appear to be more susceptible to rickets in infancy
there is greater mischief wrought amongst them in the way of dental decay through
defective structure of the teeth at an early age.
Cleanliness.
The ministrations of the school nurses pursued without intermission over many
years have completely revolutionised the conditions of the children in regard to
personal hygiene. When the first tentative work in this direction was undertaken
about 1902, a very shocking state of affairs was revealed. Over three-quarters of
the girl pupils were found to be infested with head lice and the presence of body
vermin was very common. For some years now, thanks to the work of the nurses
in the schools and at the cleansing stations, body vermin have become very rare,
and during the past year only 258 children out of 246,795 examined were found
infested with them.
Verminous conditions of the head have proved less tractable, especially in the
case of girls. Nevertheless, remarkable strides have been made, and the process
of improvement shows no sign of slackening during the past year. In 1913 only
67.2 per cent, of the older girls in the schools were found without traces of verminous
infestation of the hair. In 1916 and 1917 this percentage had been raised to 70,
in 1920, the figure reached 75, by 1923 it had climbed to 80, in 1924 to 82-5, in 1925
to 85.2, and in the present year to 88' 1 This progress is very encouraging, the nearer
one comes to perfection the rule is the harder progress becomes, but no slackening
is apparent in the above figures, and if the present rate of improvement could be
maintained, a few more years would see the virtual extinction of the head louse in
London as well as that of the body louse.
Dental decay.
The dental condition of the entrant infants shows little alteration. 46 per
cent, have manifest decay, and 15 per cent, have severe caries with inflamed and
septic gums. These figures have remained practically constant for several years.
Dental inspection and treatment at school has produced a very definite improvement
in the dental condition of the older children, as will be seen in the following
table relating to the twelve-year-old boys and girls :—

(1) Represents teeth apparently sound. (2; Represents caries, but not extensive.
(3) Represents considerable caries (4 or more teeth decayed) and oral sepsis.
Thus in 14 years the improvement is such that one-fifth more of the school
population now leave school with good teeth than was formerly the case. But
this represents the result of the work of an organisation which is almost entirely
remedial and only to a minor degree preventive. The figures for the entrant infants
show that no diminution in the incidence of dental caries is taking place and all
that we have so far been able to accomplish is to keep its ravages to some extent in
check during school life. The teeth of the children with whom the school dental
service has to deal are already to a great extent preformed (although not necessarily
erupted) before the children come to school. The work of Mrs. Mellanby for the
Dental Decay Committee suggests that impropei feeding and hygiene in infancy
affects the structural integrity of the teeth, and this renders the teeth more prone
to decay or, at any rate, makes the spread of decay more rapid when it starts.
The widespread and, indeed, almost universal incidence of caries is nothing
less than a calamity which has overtaken the human race. Viewing it from a broad