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the routine medical returns, as they consist in small aberrations which at the time of
examination will pass unnoticed unless especially looked for; they require, and
indeed can receive, no remedial action, and tend rapidly to disappear during school
life. Their importance lies in the demonstration that, while serious rickets has
become very much less prevalent than formerly, there still remains a large proportion
of the children whose nutrition during early infancy, long before school life has
been entered upon, has been prejudicially affected by improper feeding, absence of
sunlight, defective ventilation and general neglect of hygiene.
The opinion is growing that this widespread deleterious influence is more
important than was suspected. Hitherto we have been accustomed to worry only
about the more serious degrees of rickets, to congratulate ourselves because they
are rapidly becoming rarer and to comfort ourselves with the assurance that during
school life the bony deformities resulting tend to disappear. But now it is beginning
to be perceived that it is not alone the bony structures, upon the maldevelopment
of which the diagnosis of rickets mainly depends, that suffer, but also the general
constitution of the child to a greater degree than was formerly imagined.
The number of entrants to school who have bronchitic signs has been remarked
upon, and in these reports it has always been considered that this excess of bronchitis
has been connected with a rickety constitution. But we are now beginning to see
more clearly that the care and management of the infant children before school
age is the most fundamental of all the influences which affect the health and physique
of the children. The school medical service inherits children whose constitution has
been already compromised. The great scourge of dental caries which takes such a
preponderant place in the anxieties of the school medical service can only be
mitigated when the children are allowed by proper management and care in the
pre-school years to have from the beginning teeth well formed and strong to resist
decay. The macroscopic effects of rickets disappear, but are we certain that the
microscopic effects do not remain ? In the case of the teeth there is evidence to show
that it is the case that they do remain. It is even being suggested now that the
incidence of adenoid growths and enlarged tonsils is chiefly upon children whom painstaking
investigations will show to have suffered from rickets in infancy, if only to
such minor degree as not to have occasioned remark or discovery.
More and more it is borne in upon us that the part of the school medical service
must remain to a large degree remedial rather than preventive, and we must look
for the lightening of its burdens to preventive work which must be done at the
earliest ages long before school life commences.
Other
deformities.
Deformities other than those having their origin in rickets were reported in
2,722 children, of these 1,010 were spinal curvatures. 378 of these were found in
the older girls, being twice the incidence upon older boys. They consist chiefly
in postural lateral curvature of the spine, which by appropriate exercises in school
can generally be corrected without recourse to further treatment.
The health of
the child
leaving
school.
In 1925 at the urgent request of the local associations of care committees and
other interested bodies, the examination of all children about to leave school which
had for some years been in abeyance was restored. In 1926 the whole of the school
leavers were inspected comprising 31,301 boys and 31,798 girls. On the whole the
results of this inspection are very satisfactory. They demonstrate that during the
last two years of school life there is a special intensification of effort to get defects
remedied before the children leave school and to fit them as far as possible for
industrial life.
Enlarged tonsils and adenoids were reported in 5.8 per cent. of the boys as
compared with 7.2 per cent. at age 12, and in the girls in 6.9 as compared with 8.9
per cent. Poor nutrition was reported in 4.9 per cent. of leaving boys compared
with 6.7 at age 12, and in 43 per cent. of girls compared with 6.3.